Apply Now

Apply For Children's Services Now

Applying for Children's Services is easy! Just fill out the form below!

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Please fill out the form below. Upon completion, one of our team members will contact you within 5 business days to continue the application process.

We will at that time need the following documents:

Your child’s birth certificate
Your child’s Immunization records
Your child’s medical insurance info, if available
Proof of income

Do you qualify? Determine your income eligibility here.

Wish to find out if we have a Center Based or Family Child Care Center in your neighborhood?
Take a look at our location finder.

 

 

Just 4 simple steps to apply

Child's Legal Name

Name *
DOB *
Race *
Gender *
Hispanic/Latino *
Language *
Address *
Mailing Address
Health Insurance *
Physician Name
Date of Last Physical Exam
Dental Insurance *
Dentist Name
Date of Last Dental Exam
Diagnosed Medical Issues *
Does your child require daily mediation for diagnosed medical issues *
Diagnosed Disabilities *



Parent / Guardian Information

Name
DOB *
Martial Status *
Relationship to child *
Pregnant *
Due Date *
Language *
Email Address *
Race *
Hispanic/Latino *
Main Telephone *
Cell
Are you currently enrolled in school/training? *
Name of School
Highest level of education *
Are you currently working *
Sources of Income? *

Parent / Guardian Information(2nd Parent)

If there is no 2nd parent, press next on the bottom of the page to go to page 4
Name
DOB
Martial Status
Relationship to child
Pregnant
Due Date
Language
Email Address
Race
Hispanic/Latino
Main Telephone
Cell
Are you currently enrolled in school/training?
Name of School
Highest level of education
Living in the home
Are you currently working
Sources of Income?

Family Status

Family Members *
Child Information *
Name DOB Gender

Has your family experienced any of the following in the past 12 months? *
Does your family receive WIC? *
Does your family receive CalFresh? *
Please add any other concerns you have for your child and/or your family:

Spoken *
Written *

Does your family *

Are you or an immediate family member currently employed by KidZCommunity? *

How did you hear about our program? *

You may be required to provide additional documents from your health care provider(s) and/or your special education provider(s) prior to your child attending the program.In addition, a special written plan may need to be agreed upon prior to your child attending the program. All submitted information will be kept confidential.

  I certify the information I have provided is accurate to the best of my knowledge. I understand I must provide all required documentation in order for my application to be processed. I understand that completion of this application does not guarantee enrollment.