Harnett County Cooperative Extension Harnett County Cooperative Extension Harnett County Cooperative Extension Harnett County Cooperative

Extension
Harnett Count Harnett Count Harnett Count Harnett County Child Care Resources y Child Care Resources y Child Care Resources y Child Care Resources
126 Alexander Dr., Suite 300 126 Alexander Dr., Suite 300 126 Alexander Dr., Suite 300 126 Alexander Dr., Suite 300, , , , Lillington, NC 27546 Lillington, NC 27546 Lillington, NC 27546 Lillington, NC 27546
910 910 910 910- -- -893 893 893 893- -- -75 75 75 7530 30 30 30

Bringing parents, child care providers and community together for the sake of our children.
North Carolina State University and North Carolina A&T State University commit themselves to positive action to secure equal opportunity regardless of
race, color, creed, national origin, religion, sex, age, or disability. In addition, the two Universities welcome all persons without regard to sexual orientation.
North Carolina State University, North Carolina A&T State University, U.S. Department of Agriculture, and local governments cooperating.




ABC Music & Me

Interest Form


Name of Child Care Program: ________________________________________

Phone Number: ____________________________________________________

Address: _________________________________________________________



Please answer questions below:


Which age group / classroom would you like to participate in ABC Music & Me? (Please circle one)

Infant/Toddler Twos Preschool School-Age

How many are currently enrolled in the age group / classroom you selected to participate in the ABC Music & Me
program?
__________

Are there any military children involved in the age group / classroom? If yes, how many?

__________



I _________________________________________ am verifying that the information listed above is accurate and
truthful to the best of my knowledge. I understand that due to limited funding, all interested programs may not be
selected and that this interest form is not a guarantee that my site will be selected to participate in the ABC Music &
Me program.


Owner/Directors Signature: ___________________________________ Date: __________________________



Please return interest form to Harnett County Child Care Resources no later than Friday, August 15, 2014.