CAHS Online Enrollment Form | Keystone Human Services

Contact Information

Would you like someone to contact you about enrolling your child in Capital Area Head Start? Submit your contact information below and someone from CAHS will contact you within two business days.

CAHS Online Enrollment Form - ** indicates required fields

Name^**

Child's Name*

Child's Date of Birth*

Address^**

Address 2

City^**

State^**

Zip Code^**

Telephone Number^**

Alternate Telephone Number

E-mail Address^**

Please review the above information prior to submitting.
If correct, submit the information using the button below.