Enrollment

Welcome to the Cops ‘n Kids Family!

We are committed to empowering children and teens for lifelong success and greater quality of life.

Step 1: Check Eligibility

Before applying, make sure your child meets all three requirements:

Step 2: Complete the Application

Once you have confirmed that your child qualifies, complete the Cops ’n Kids Youth Center enrollment application.

Step 3: Submit the Application

You can submit the completed application in either of two ways:

Email: jamilet@copsnkids.org

In Person:
Cops ’n Kids Youth Center
555 East Harrison Street
Tarpon Springs, FL 34689

Step 4: Join the Waitlist

Once your application is received, your child will be placed directly on our waitlist.
Our waitlist is organized by four age/grade groups:

Step 5: Wait for an Opening

When an opening becomes available in your child’s appropriate group, families will be contacted with information about enrollment.

Questions?

If you have questions about eligibility, the application, or the waitlist, please contact the center and ask for Jamilet Farley.

Please fill out the attached papers as completely and accurately as possible and do not leave any blanks.

Child’s Enrollment Record

A. Please enter child Information

First name *

M.I. *

Last Name *

Nickname *

Date of birth *

Sex *

Primary hours of care *

Days of week in care *

Child's Physical Address

City

State

Zip Code

B. Please enter family information

Child lives with

Mother's name

Father's name

Address

Home Phone

Address

Employer

Employer Address

Work Phone

Cell

CustodyMotherFather

Other

C. Emergency Contacts

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the children's center in case of illness, accident or emergency, if the custodial parent(s) or legal guardian(s) cannot be reached.

Name *

Home Phone *

Cell Phone *

Address

City

State

Zip Code

Please use additional fields to list name, address and phone number of any other people authorized to pick the child up.Add Another Emergency Contact

Name

Home Phone

Cell Phone

Address

City

State

Zip Code

D. Medical Information

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the children's center in case of illness, accident or emergency, if for some reason the custodial parent(s) or legal guardian(s) cannot be reached:

Child's Physician/Health Resource

Telephone Number

Address

City

State

Zip Code

Hospital Preference

Name of Dentist

Telephone Number

Address

City

State

Zip Code

Emergency Care Plan Instructions (if applicable)

E. Miscellaneous Information

List all known allergies

List all identifying scars, birthmarks, skin discolorations

Special medical or dietary needs of child

List any areas of concern

Please download and print the full form to add a handwritten signature and view any other legal forms required by Cops 'N Kids Youth Center.

Enrollment

We are committed to empowering children and teens for lifelong success and greater quality of life.

Step 1: Check Eligibility

Step 2: Complete the Application

Step 3: Submit the Application

Step 4: Join the Waitlist

Step 5: Wait for an Opening

Questions?

Please fill out the attached papers as completely and accurately as possible and do not leave any blanks.

Child’s Enrollment Record

A. Please enter child Information

B. Please enter family information

C. Emergency Contacts

D. Medical Information

E. Miscellaneous Information

My signature below verifies that: