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Child enrollment Form: What You Should Know

Use of form: Use of this form is mandatory for Family Child Care Centers to comply with DCF 250.04(8)(d). Child Enrollment Authorization Form (COAP2). March 19, 2020. Twitter Facebook Share  For questions regarding the use of this form, please contact the Health Professional at the local Department within three (3) days of the date of issuance. For questions regarding the use of this form, please contact the Health Professional at the local Department within three (3) days of the date of issuance.  SUMMARY OF COURSES. Use of this form is mandatory for Family Child Care Centers to comply with DCF 250.04(8)(c), (c)2. To request an Individualized Family Education Plan (IEP) you must complete the following forms, at least three (3) days apart. In order to be eligible for this funding, a family must complete and sign this form. If your child does not attend the program for the period specified, your child's IEP will remain active; he or she must be enrolled in the school in good standing. It is your responsibility to provide the information requested and the completed form is due prior to receiving a reimbursement.  If you are unsure if you need to present an IEP, or need information for your IEP application, please call or give us a call by phone. MUST READ. You must complete the form at least three (3) days prior to the beginning of your child's first week in the program. You must complete the child's IEP by the end of the day after the child's first week. If you do not provide the information requested, your IEP will remain active. It is your responsibility to provide the information requested and completed form is due prior to receiving a reimbursement. If you do not have a copy of this form, please request one at any time.  The number for your state Medicaid agency is provided below. This is important information that was put in place to protect children. It is imperative that Medicaid recipients are aware of this requirement.  If you do not comply with the child's enrollment. Children will not not be able to receive their vaccinations without first meeting with a licensed healthcare provider. The healthcare provider will determine if the child is compliant with the law and must submit this information to an authorized state health official.

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Video instructions and help with filling out and completing Child enrollment form

Instructions and Help about Child enrollment form

Would you like to come on Tuesday or Wednesday evening Wednesdays okay Wednesday's great and then your your name is Mike Edwards right right okay and I would you be bringing any other parent or caregiver with you yeah my wife will be coming great and what's her name Amy Amy and is that Edwards mm-hmm what okay and then your first graders name is Marya is that Edward Cobb well that's correct right and she's in this is Jones class yes okay and then I'm calling you on your cell phone so that's five five five three one two one three one two is that right well that's correct okay and it would be okay with we text you if we wanted to send you a message or a reminder something like that yes sure no problem great do you have any other phone numbers like a home number or a work number no the cell phones it okay and if you have an email address yep sure it's Mike dot Edwards at stop net okay so that's Mike mi ke dot Edwards you dwar D F at net mm-hmm that's great great and what's your mailing address 12:21 South 5th Street here in Mesa ok so that's 12 21 South 5th Street in Mesa do you have an apartment where unit number no no it's a single-family home ok great and what's the zip code eight five two zero five okay great you're enrolled in the English group on Wednesday great.