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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's 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

Is your child potty trained? 

(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:
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
Staff and Community Parents in need of Childcare:

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 enrollment
The State Preschool Program is located at the Escondido Center for income eligible families that are in need of childcare due to employment, work participation requirement, or educational / job training. Children ages 4 years old by Dec. 2.  This program is 3 hours long Monday through Friday.
Child Care Hours Needed :   FALL'08  SPRING '09

 SUMMER '09

Monday

Tuesday Wednesday  

Thursday Friday     

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