Re-instatement of Enrollment This form is to be used if a child re-enrolls in the school year session.  

West River Head Start

Re-instatement of Enrollment

This form is to be used if a child re-enrolls in the school year session.

      (child's name) is to be re-enrolled in the West River Head Start program.
Date of re-enrollment:      
This is a re-instatement of enrollment which ended on       (date).
Name of parent/guardian:      
Address:      
Phone number(s)

Home:      

Cell:      

Work:      

Reason for re-enrollment:      

Original: Family Support Coordinator (child’s file)

Copies: Administrative Assistant

Assistant Director

CACFP Coordinator

Class List Coordinator

Classroom Teacher

Transportation Coordinator

Revised 3/24/2014