Parent Name *

First Name

Last Name

Child Name *

First Name

Last Name

Child DOB *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Have you already received a VPK Voucher?

If not, first visit: https://www.elcbroward.org/vpk

Yes, I have already received a VPK Voucher.

This is not a guarantee of enrollment.

All enrollment forms and fees must be paid after welcome meeting with director

I understand