• Pueblo of Laguna • Division of Early Childhood

    Pueblo of Laguna • Division of Early Childhood

    Registration Application - Program Year 2026-2027

  • For school year 2026-2027, the Laguna Division of Early Childhood school hours:


    Early Head Start school hours will be Monday – Friday 7:30 a.m. – 3:00 p.m.
    Preschool Head Start school hours will be Monday – Friday 7:30 a.m. – 3:00 p.m.

    Childcare hours will be:

    • Early Head Start 3:00 p.m. – 5:00 p.m. (Monday-Friday)
    • Preschool Head Start 3:00 p.m. - 5:00 p.m. (Monday – Friday)
    • NO Child Care on Staff Professional Development days.

    All new and returning children must have a completed application for school year 2026-2027.

    All supporting documents will need to be turned in within 45 days of enrollment. Missing documents could affect the status of your child in the program. DEC staff can assist you, if necessary.

    Documents needed for NEW students:

    • Immunization record
    • Birth certificate
    • Well child check-up (for current age at time of enrollment)
    • Legal guardian MUST provide current legal documentation (i.e., court order verifying custody of the child being enrolled)
    • Dental Exam (current)

    Returning students will receive an application/letter stating which documents will be needed to complete their application.

    Any questions pertaining to applications/childcare should be directed to Patricia Charlie at 505-552-6544 ext 5004.

    Applications can be emailed to dec-registration@lagunaed.net

    Reminder, Head Start slots are available on a first come, first serve basis. Applications are considered complete when all required documentation is received.

  • Child's Name

  • Date of Birth*
     / /
  • Gender

  • Address

  • Phone Numbers of Parents/Guardian

  • General

  • Do you have other children in a DEC program?
  • Is your child receiving disability services (Early Intervention/IEP/IFSP)?
  • Are you currently receiving WIC?
  • Primary Language of Child/Family

  • Parent/Legal Guardian 1

  • Date of Birth
     / /
  • Do both parents have legal custody?
  • Supporting legal documents/court documents?

  • Address

    (if Different from Applicant)
  • Teen Parent? (Currently 18 years old or younger)

  • Parent/Legal Guardian 2

  • Date of Birth
     / /
  • Do both parents have legal custody?
  • Supporting legal documents/court documents?

  • Address

    (if Different from Applicant)
  • Teen Parent? (Currently 18 years old or younger)
  • Today's Date:
     / /

  • EMERGENCY CONTACTS/RELEASE FORM

  • The Laguna Division of Early Childhood requests that each child have a minimum of two current emergency contact numbers on file. Please be certain that contact numbers listed are currently in service.

    Child Release from Program or Preschool Head Start Bus Check-out Information: We are unable to release a child to any unauthorized person or to an individual appearing to be under the influence of alcohol or drugs. We cannot release a child to any person under the age of 18, from the center or from program activities such as field trips, unless that person is the parent. Identification (picture ID or driver's license) may be required before a child is released. We cannot release a child to a person who does not have an approved car seat.

    Please note, it is DEC Policy that a person who is listed on the sex offender registry cannot be named as an emergency contact, pick up a child from the program, take a child off the bus, or participate in any DEC activity.

    REMEMBER: ANY CHANGES OR UPDATES MUST BE MADE IN PERSON

  • Emergency Contacts / Program Check-outs / Head Start Bus Check-outs

  • Parent/Legal Guardian - Primary Contact 1

  • Release child to this contact?

  • Parent/Legal Guardian - Primary Contact 2

  • Release child to this contact?

  • Contact 3

  • Release child to this contact?

  • Contact 4

  • Release child to this contact?

  • Contact 5

  • Release child to this contact?

  • EMERGENCY MEDICAL CONSENT

    This form is taken on field trips and kept in the child’s classroom and the bus

  • In case of an emergency, I hereby consent to diagnosis and/or treatment (diagnostic procedures, surgical and medical treatment, and blood transfusion) by authorized members of the hospital staff which in their professional judgment is deemed necessary.

    I hereby acknowledge that no guarantees have been made to me as to the effect of such examination or treatment of the child’s condition.

    I hereby give my consent for the child named above to be transported for emergency medical procedures or emergency dental care necessary to preserve the health and life of my child for program year: 2025-2026. I acknowledge that I am responsible for all reasonable charges in connection with such emergency care and treatment.

  • Does your child have medical insurance?
  • Special Care Plan required?
  • Today's Date
     / /
  • Date of Birth
     / /

  • PERMISSION FORMS

  • PERMISSION TO PHOTOGRAPH AND/OR VIDEO RECORDING

  • Permission for my child to have his/her photograph taken by the staff of the Division of Early Childhood. I understand that these photographs are for the promotion of self-esteem, self-identity, and for tracking each child’s developmental progress and other classroom use.

  • I understand that this permission form is valid for program year: 2026-2027

  • Today's Date
     - -

  • PERMISSION TO POST PICTURES OF CHILD ON FACEBOOK and/or LDOE WEBPAGE

  • Permission to post pictures of my child on the LDOE Facebook page and/or the Laguna Department of Education website(s)
  • Date
     - -

  • PERMISSION TO POST PICTURES OF CHILD IN NEWSLETTER

  • Permission to post pictures of my child on the LDOE Facebook page and/or the Laguna Department of Education website(s)
  • Date
     - -

  • PERMISSION TO INCLUDE PICTURES OF CHILD ON BULLETIN BOARDS

  • Permission to post pictures of my child on DEC bulletin boards and newsletters
  • Date
     - -

  • CONSENT FOR SCREENING/ASSESSMENT

  • I understand that for Program Year 2026-2027 my child is to have screenings and assessments completed in order to gain information about his/her development and progress. I understand the office of Head Start requires child and family data for reporting purposes, including required reporting from the office of Head Start. All information will be kept confidential.

  • Statement to Parents/Guardians:

    1. Health and developmental screenings noted in the paragraph above are part of Head Start requirements.
    2. You will be informed of the results and may request copies of any screenings and assessments and other records.
    3. All screening, assessment, and other records in your child’s name will be kept confidential.
    4. I understand that Head Start programs are required to conduct developmental screenings and have evidence of completion of a physical examination and health screenings within 45 days of the child’s enrollment.
  • Date:
     / /

  • Administer Topical Solution

  • The Preschool Head Start Program is requesting permission to administer topical solutions to your child during DEC program hours. Topical solutions are sprays, ointments, or creams that can be applied directly to skin. Please check the topical solution(s) of which you give permission to be used for your child while in the program.

  • Date of Birth
     - -
  • I authorize the DEC staff to use the following on my child when needed:
  • Today's Date:
     / /

  • Authorization to Release or Receive Information

    The purpose or need for this disclosure is for program enrollment and ongoing health and developmental information.
  • Date of Birth
     - -
  • The information to be disclosed from my child’s record may include:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • By checking and signing below, I hereby authorize the sharing of information regarding my child.
  • Today's Date
     - -

  • Physical Residency Questionnaire

    McKinney-Vento Act
  • Date of Birth
     - -

  • Section 1

    The answers to the following questions can help determine the physical residency of the child.
  • A. Is this child’s physical address a temporary living arrangement?
  • B. Is this a temporary living arrangement due to a loss of housing or economic hardship?
  • C. Is this child in a temporary foster care placement or awaiting foster care?
  • D. Is the child living with someone other than the parent or legal guardian?

  • If you answered YES to any of the above questions, please answer the following:

  • If you answered NO to questions a, b, c, and d please skip section 2 and go to section 3

  • Section 2

    Current Living Situation
  • Where is the child currently living? (Check the box that best describes the child’s circumstance)
  • Today's Date
     - -

  • School Screening, Fluoride Varnish, Dental Sealant Consent

    Note: All procedures rendered at these visits are billable to Medicaid and third party insurance as authorized in the Indian Health Care Improvement Act

  • Indian Health Service Dental Program will be offering free dental screenings, fluoride varnish and sealants at your child's school.

    Fluoride Varnish

    • Procedure: Fluoride varnish is applied directly onto the teeth.
    • Benefits: Fluoride Varnish coats the outside of the tooth and makes it resistant to a cavity.
    • Risks: Used in the proper amount, fluoride varnish is safe and effective.

    Dental Sealants

    • Procedure: A Plastic coating is applied on the chewing surface of the back teeth.
    • Benefits: Sealants help prevent cavity-causing germs from getting stuck in the deep groves in the back teeth.
    • Risks: There are no known commonly occurring adverse effects or hazards associated with dental sealants.

    Preventive Services provided by Indian Health Service at your Child's school DO NOT replace a regular dental checkup. We will send a notice home with your child of all retreatment they received in school.

  • Below, please check if you DO NOT WANT YOUR CHILD TO PARTICIPATE in all or part of the prevention services:
  • Student's Date of Birth
     - -
  • Date
     - -

  • Afternoon Child Care

    School Hours & Child Care hours HAVE CHANGED for SY26-27

  • For school year 2026-2027, the Laguna Division of Early Childhood school hours:

    • Early Head Start school hours will be Monday – Friday 7:30 a.m. – 3:00 p.m.
    • Preschool Head Start school hours will be Monday – Friday 8:00 a.m. – 3:00 p.m.

    Childcare hours will be:

    • Early Head Start 3:00 p.m. – 5:00 p.m. (Monday-Friday)
    • Preschool Head Start 3:00 p.m. - 5:00 p.m. (Monday – Thursday)
    • NO Child Care on Staff Professional Development Days

    In order to qualify for child care services, parents must be working and/or in school. Please provide:

    • 2 current check stubs and/or class schedule (if taking classes) and
    • DEC child care application. Childcare rates are based on family’s income/family size.
  • Please indicate which childcare services you will need:

  • Upload Required Documents

    • Immunization record
    • Birth certificate
    • Well child check-up (for current age at time of enrollment)
    • Legal guardian MUST provide current legal documentation (i.e., court order verifying custody of the child being enrolled)
    • Dental Exam (current)
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Certification: I certify that this information is true, if any part is false, my participation in this agency’s programs may be terminated and I may be subject to legal action. I also understand that the information in this application will be held in strict confidence within the agency, and is accessible to me during school hours.

  • Should be Empty: