Enrollment Application

"*" indicates required fields

Child's First Name (Nombre de Niño)*

Last Name*

Middle Name

DOB (Fecha de Nacimiento)*

Age (Edad)

Sexo*

Male

Female

Home Phone (Telefono)*

Address (Direccion)

Email Address*

Select Program*

Name of Elementary School child will be attending Kindergarten. (¿Nombre de la escuela publica que el Niño(a) va atender en Kinder?)

Has your child previously attended any type of Early Childhood Program? (¿Su hijo ha atendido algún programa de niñez en el pasado?)

If yes, please indicate the program attended. (Por favor indique el programa atendido.)

Have you been referred by another early childhood program? (¿Es usted referido por otro programa de niñez?)

If yes, please indicate the program. (Por favor indique el programa.)

Select Preferred Location

Center

Court

Missouri

Northrise

Sonoma

Valley A

Valley B

PARENT(S)/LEGAL GUARDIAN(S)

Parent/Guardian (Nombre de Padre/Tutor Legal)*

Relationship to Child (Parentesco con el Nino/a)*

Parent/Guardian (Nombre de Padre/Tutor Legal)

Relationship to Child (Parentesco con el Nino/a)

Children meeting the age requirements (must be 4 years old by Sept 1st) are eligible for selection for the Pre-K Program regardless of income or disability and will be selected by lottery.

Niño's que satisfacen el requisite de edad (4 anos para el 1 de septiembre) son elegibles para la selección del programa Early Pre-K sin tener en cuenta los ingresos o incapacidades y seran escogidos por loteria.

ACKNOWLEDGEMENT (CERTIFICACION)

I acknowledge by my signature below that I have read and understand the questions on this form and the requirements to enroll my child in The Children's Garden Early Pre-K Program. All information will be held in strict confidence.

Yo certifico que entiendo las preguntas y he leido o se me han explicado esta forma y los requisitos para inscriber a mi nino (a) en el programa de The Children's Garden Early Pre-K. Toda informacion sera mantenida bajo estricta confidencia.

Signature of Parent/Legal Guardian (Firma de Padre o Tutor Legal)

Date (Fecha)

CAPTCHA

This field is for validation purposes and should be left unchanged.

S. Valley Dr. Building A

S. Valley Dr. Building B

E. Court Ave

Missouri AVE

Northrise Dr

Sonoma Springs

Enrollment Application

PARENT(S)/LEGAL GUARDIAN(S)

ACKNOWLEDGEMENT (CERTIFICACION)

We Have 6 Locations To Serve You

S. Valley Dr Building A

Director: Lysandra Garcia

S. Valley Dr Building B

Director: Krystina Palacios

E. Court Ave

Director: Priscilla Salcido

Missouri AVE

Director: Shannon Flores

Northrise Dr

Director: Stacey Ramirez

Sonoma Springs

Director: Vivian Esparza