Pre Registration Existing Cape Care Families - Cape Elizabeth Community Services

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Child's Last Name *

Child's First Name *

Child's Primary Residence *

Address Line 1

Address Line 2

City

State

Zip Code

Gender *

Grade (Fall 2024) *

Date of Birth

Age *

Individual Education Plan (IEP) as determined by Child Development Services. For more information https://www.maine.gov.doe/learning/cds

Has an IPE
Does not have an IPE but has concerns
None of the above

Qualifies for economically disadvantaged services?

Speaks or hears another language besides English at home?

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Parent/Guardian 1 *

First

Last

Home Phone 1 *

Cell Phone 1 *

Work Phone 1 *

Email 1 *

Address

Same as child

Parent/Guardian 1 Residence (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian 2

First

Last

Home Phone 2

Cell Phone 2

Work Phone 2

Email 2

Address

Same as child

Parent/Guardian 2 Residence (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Pre-Registration Fee

A non-refundable pre-registration fee of $50.00 is required (Except for Pre-Kindertgarten).

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Name *

Card Number *

Expiration Date *

Security Code *