Enrollment Application

Save a spot for your little dreamer

Fill out the application below and our director, Marquisha Johnson, will reach out to schedule a visit. We welcome children ages 1 through 12.

Mon–Fri2:00 – 8:00 PM

Meals includedSnacks too!

Ages 1–12All are welcome

About your child

Child's full name

Nickname (optional)

Date of birth

Age group

Gender

School / grade (if applicable)

Preferred start date

Usual pick-up time

Parent / guardian

Your full name

Relationship to child

Phone number

Email address

Home address

Employer (optional)

Work phone (optional)

Second parent / guardian

Their phone number

Emergency & pick-up

Emergency contact name

Emergency contact phone

Authorized pick-up people

Health & care

Doctor / clinic

Doctor's phone

Allergies & dietary needs

Medical conditions or medications

Anything else we should know? (routines, comfort items, questions…)

How did you hear about us?

I give permission for photos of my child to be used in Little Dreamers Academy activities and social media.I certify the information above is accurate and I agree to be contacted about this application.

909 Main Street, Rosedale, Mississippi · Open Monday–Friday, 2:00–8:00 PM