Head Start & Early Head Start Pre-Registration Form

Please complete the form below and click Submit

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TVCCA Childcare Programs 860-425-6586

Head Start Pre-Registration Form

CHILD 1 APPLICANT INFORMATION

First
Last

CHILD 2 APPLICANT INFORMATION

First
Last

ADULT INFORMATION

First
Last

FAMILY CONTACT INFORMATION

Address
City
State/Province
Zip/Postal
Country

Please Note: Due to the abundance of children on our applicant pool, if we try to contact you and do not have a correct phone number or we don’t get a return phone call within 24 hours you will be moved to the inactive list.