Application

Description: http://www.palomar.edu/childrenscenter/applcation/cdc.gif
If you are unable to print this form and bring it to the Child Development Center, please click here for a form that can be submitted online.

Home Page

Student

Staff

Community

Cal-Works

San Marcos

Escondido

Child's Name:

Birth date:

Philosophy

Sibling's Name:

Birth date:

Do both your children need to be enrolled on the same days and hours?

Yes No

Parent Name:

Student I.D.

Address:

City:

Zip:

Phone Number : (Day)

Cell Phone

E-mail address:

Does your child have any disabilities or limitations that require accommodations? Yes No If yes please describe:
_______________________________________

Is your child toilet trained? Yes No

(We ask this for our awareness and to be better able to serve your child and his or her needs.

** If you need to apply for Student Subsidiary or State Preschool, Please give us the following information. This information needs to be on the application to properly code your application.

**INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**

How many are in your immediate family?

Gross monthly income

Source of Income:

Salary

AFDC

SSI

Child Support

Unemployment

Do you participate in any funding sources that will pay for your childcare? Yes No

If so, please name the source (s) :

Palomar Students in need of Childcare:

Your child's enrollment days and hours will be based on your class schedule which may include study hours. There is a sliding scale depending on your income and family size. Call the San Marcos Center for more information.

Staff and Community Parents in need of Childcare:

For families whose income does not qualify for funding, please call the Center (760) 744-1150 ext. 2575 for current rates. A Nonrefundable registration / materials fee of $90.00 is due at time of confirmed enrollment.

Escondido Center has only 3 hour State Preschool Programs are available free for income eligible families for children who are 4 years old by Dec. 2 . The purpose of the state preschool program is to prepare children for kindergarten for the following year. Children are enrolled 5 days a week, 3 hours per day, Monday through Friday. Times for these programs are 8:30-11:30am, 9am-12pm, 1:30-4:30pm or 2-5pm.

Child Care Hours Needed :

FALL ’12 Yes No

SPRING’12 Yes No

SUMMER '12 Yes No

Monday

Tuesday Wednesday

Thursday Friday

Fill in information, print out form and bring to the Center.

To e-mail contact: msanchez@palomar.edu

San Marcos

Escondido

Philosophy

If you are unable to print this form and bring it to the Child Development Center, please click here for a form that can be submitted online.
Home Page	Student	Staff	Community	Cal-Works
San Marcos
Escondido	Child's Name:			Birth date:
Philosophy	Sibling's Name:			Birth date:
Do both your children need to be enrolled on the same days and hours?				Yes No
Parent Name:			Student I.D.
Address:			City:	Zip:
Phone Number : (Day)			Cell Phone
E-mail address: Does your child have any disabilities or limitations that require accommodations? Yes No If yes please describe: _______________________________________ Is your child toilet trained? Yes No (We ask this for our awareness and to be better able to serve your child and his or her needs.
If you need to apply for Student Subsidiary or State Preschool, Please give us the following information. This information needs to be on the application to properly code your application. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
How many are in your immediate family?			Gross monthly income
Source of Income:	Salary	AFDC	SSI Child Support	Unemployment
Do you participate in any funding sources that will pay for your childcare? Yes No
If so, please name the source (s) :
Palomar Students in need of Childcare:		Your child's enrollment days and hours will be based on your class schedule which may include study hours. There is a sliding scale depending on your income and family size. Call the San Marcos Center for more information.
Staff and Community Parents in need of Childcare:		For families whose income does not qualify for funding, please call the Center (760) 744-1150 ext. 2575 for current rates. A Nonrefundable registration / materials fee of $90.00 is due at time of confirmed enrollment.
Escondido Center has only 3 hour State Preschool Programs are available free for income eligible families for children who are 4 years old by Dec. 2 . The purpose of the state preschool program is to prepare children for kindergarten for the following year. Children are enrolled 5 days a week, 3 hours per day, Monday through Friday. Times for these programs are 8:30-11:30am, 9am-12pm, 1:30-4:30pm or 2-5pm.
Child Care Hours Needed : FALL ’12 Yes No SPRING’12 Yes No SUMMER '12 Yes No Monday Tuesday Wednesday Thursday Friday
Fill in information, print out form and bring to the Center.		To e-mail contact: msanchez@palomar.edu			San Marcos	Escondido	Philosophy