Hancock County Child Development Wait List

Child Development Center: 9930 Highway 603, Bay St. Louis, Mississippi 39520
STARS Early Education Center: 18555 MS-43, Kiln, Mississippi 39556
Camp Care: 7150 Lower Bay Road, Bay St. Louis, Mississippi 39520
STARS East Aftercare: 4221 Kiln Delisle Road, Kiln, Mississippi 39556
STARS North Aftercare: 6122 Cuevas Town Road, Kiln, Mississippi 39556
STARS West Aftercare: 23350 Highway 43, Picayune Mississippi 39466

You MUST Submit before leaving this form or ALL entries will be lost.

Child

Enter the child's full name (example: use Joseph not Joe)

First name *

Last name *

Gender *

Male

Female

Date of birth * +

DHS custody *

Yes

No

Select the location where your child will attend

Location *

Parent or legal guardian

First name *

Last name *

Relationship to child *

Primary telephone *

Email address *

Second parent or legal guardian

Second parent or guardian

No surviving second parent or legal guardian

First name *

Last name *

Relationship to child *

Primary telephone *

Email address *