Washita Valley Community Action Council

Head Start/Early Head Start Enrollment Application


In addition to completing the online enrollment application, the following documents are needed to complete the enrollment process:


  • Proof of Date of Birth - Copy of birth certificate, hospital record or other official document with the date of the child’s birth. (required).

  • Income for 12 month period – Income tax statement, prior year W-2, check stubs with year-to-date income, SSI document, child support statements, employer Statement on letterhead. (required).

  • Immunization Record/Exemption – Refer to appendix II, immunizations, in Requirements for Child Care Programs for immunization and exemption procedures.

  • Completed Consent Page – Must contain parent/guardian signature (required).

  • Health Insurance Card – Attach a copy, if available (not required).

  • Social Security Card – Attach a copy, if available (not required).

  • Parent and Staff Signatures – Required.




  • Attach a copy of the child’s immunization record. An immunization record or exemption is obtained prior to the first day of attendance and is to be kept updated when the child receives additional vaccines.

  • Parent/Guardian must provide a copy of the current immunization record to the child care program. Refer to appendix ll, Immunizations, in Requirements for Child Care Programs for immunization and exemption procedure.

  • Selecting Child Care Programs, DHS publication “A Parent Guide” 87-91, Licensing Requirements for Child Care Programs, DHS publication 14-05, and the program compliance file are all made accessible to parents in a prominent location.

Application Process:

  1. Fill out the web based Application HERE

  2. Attach Application, and any other documentation required.

  3. Turn In Application and Documents:
    - By scanning and sending via email to: enrollmentcoordinator@washitavalleycac.com
    - By mail to: PO Box 747, Chickasha, OK 73023      

       - Drop off: 1000 W. Minnessota Ave., Chickasha, OK 73018


1000 West Minnesota Avenue

Chickasha, OK 73018


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