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Harvest of Little Seeds Enrollment Forms

Child Registration Form

School Entrance Health Form

​Instructions:

  • Print out both forms and have completed

  • School Entrance Health Form, must be completed by your child's Primary Care Physician 

  • A copy of your child's most recent Physical Exam

             *Must be signed by Physician

  • A copy of your child's updated Immunization Records

            *Must be signed by Physician 

  • Child Registration and School Entrance Health Form must be returned to Director

Director: Kamika Culmer 

8197 Courthouse Road Louisa, VA 23093

Phone: 434.806.7605 (Cell)     540.603.2025 (Daycare)    

Email: HarvestOfLittleSeeds@yahoo.com

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