Early Childhood Center Online Forms

Please select the form of your choice by clicking on the desired form bar. Once you have successfully submitted the form, someone will reply to you as quickly as possible to acknowledge your submission and if appropriate let you know if further information is needed. Thank you for your interest!

Note: Once you have submitted the form, please make sure you receive a successfully sent message (“Thank you…”) in a green box below the appropriate submit button.

(All fields with an “*” are required)

ECC Interest Form...

    Child 1

    Child 2

    Child 3

    I am interested in Extended Care

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    ECC Enrollment Form...


      Childs Name:








      MaleFemale

      Childs Address:






      Parent/Guardian Information

      Address:







      Work Address:






      Second Parent/Guardian


      Address:







      Work Address:






      Emergency contacts other than Parents(s)/Guardian or Doctor – At least one required:

      Person(s) authorized to take child from center
      Medical Information:
      I understand that I will be notified at once in case of accident or illness involving my child, and I will make arrangements for medical care of my child with the Physician or hospital of my choice.

      If I cannot be reached to make necessary arrangements, or in a critical emergency requiring medical care, I hereby authorize St. Lucas Early Child Care Center to contact:


      General Information:

      YesNo
      Agreements:
      • When my child is ill, I understand and agree that my child may not be accepted for care.
      • If your child becomes sick at school, the office staff will contact the parent immediately. The expectation is that the call is answered or returned within a short period of time or emergency contacts will be notified. Children should be picked up within the hour of the parents being notified.
      • I have been informed of the required health and safety inspections, and that the inspection forms are available for review.
      • have received the Parent Handbook, containing additional policies and procedure and a copy of the sick child policy.
      • In accordance with Section 210.003.7, RSMo, the parent or guardian of a child enrolled in St. Lucas Early Child Care Center may request notice of whether there are any children enrolled at our facility with an immunization exception on file. If you would like to request this information, please contact the St. Lucas ECC office and the information will be provided to you. Please note, the name or names of individual children are confidential and will not be released. Our response will be limited to whether or not there are children enrolled at our facility with an immunization exemption on file.
      (Type your full name as Signature)

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      ECC Waitlist Form...


        Childs Name:









        Childs Address:






        Parent/Guardian Information

        Address:







        Work Address:






        Second Parent/Guardian


        Address:







        Work Address:






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        If you are having difficulty with submitting any of the forms, email our director by clicking here. Our Director will respond to you as soon as possible. Thank you!