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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.

 

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Student

Staff

Community

Cal-Works

 

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Child's Name:

Birth date:

 

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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