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201819 Early Learning Center Registration 55 PA CODE CHAPTERS 3270.123 & 181 (c); 3280.123 & 181 (C); 3290.123 & 181 children Name: DOB: / / Age/Gr. At time of enrollment: Address: City: Zip: Home:
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To fill out a child's name, date of birth and age group, follow these steps:
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Write the child's full name in the designated space.
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Enter the child's date of birth in the format of month, day, and year (MM/DD/YYYY).
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Calculate the child's age by subtracting the birth year from the current year.
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Determine the appropriate age group for the child based on their age.
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Fill out the corresponding age group in the given field.

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- Sports or recreational organizations for age-group categorization.
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- Childcare centers or babysitters for identification and age-appropriate care.
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Child's name, date of birth, and age group are the details required for this form.
Parents or legal guardians of the child are required to file this form.
You can fill out the form by providing the child's name, date of birth, and selecting the appropriate age group.
The purpose of this form is to collect demographic information about children.
You must report the child's name, date of birth, and select the appropriate age group.
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