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7. Child's Name *

4. Second Parent's Name: *

3. Email: *

1. Parent's Name: *

8. Child's birth date (or due date) *

2. Phone number *

5. Second Parent's Phone Number: *

9. Requested Program (choose one): *

Infant Program (6 weeks-23 months) 7:30am-5:30p

Toddler Program (2 years) 7:30a-5:30p

Toddler Half Day Program (2 years) 7:30a-12:30p

Preschool Program (3-5 years) 7:30a-5:30p

Preschool Half Day Program (3-5 years) 7:30a-12:30p

12. Tuition Payments *

Private Pay

CRC/Solano Family Services

Military Subsidy

Additional Info

6. Second Parent's Email: *

10. Schedule Requested *

Monday - Friday

Monday/Wednesday/Friday

Tuesday/Thursday

13. Child's age at enrollment *

11. Requested enrollment date: *

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