Record Sheet

    Name of Parent / Guardian

    Your Email (required)

    Your Telephone

    Are you coming through a Goverment Program? Which One?

    NoCalWorksCHSDOEOptionsOther

    Child's Name, Age, Gender

    Potty Trained

    YesNo

    Child's Name, Age, Gender

    Potty Trained

    YesNo

    Expected Date of Enrollment

    Expected Attendance Schedule

    Time Schedule

    How did you discover us?

    Additional Information