Fall Childcare Interest Form
As of January, 2021 we have yet to confirm a registration date for Fall Childcare. We anticipate registration will happen in early summer. If operations resume 'as usual' we anticipate we would be able to serve most families (meaning we are able to utilize school spaces as well as City Clubhouses and mix children and staff in cohorts that do not have a maximum number). Students would need to attend the school where care is offered. This form does not register your child for care, but does ensure you will be contacted when registration information is available. Please submit one form for each child you may register.
Child's Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Primary Guardian Email
*
example@example.com
Secondary Guardian Email
example@example.com
Primary Guardian Phone Number
*
Please enter a valid phone number.
Your Child's School:
*
Fairmont
Harding
Madera
Child's Grade in Fall 2021
*
Transitional Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Type of Childcare Needed
*
Afterschool Care 5 days per week
Afterschool Care 4 days per week
Afterschool Care 3 days per week
Afterschool Care 2 days per week
Before School Care 5 days per week
Before School Care 4 days per week
Before School Care 3 days per week
Before School Care 2 days per week
Submit
Should be Empty: