Early Learning Application

Date

Child's Name

First Last

Child's Date of Birth

Please indicate which type of care you need:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Parent A Name

First Last

Parent B Name

First Last

Are you a single-parent family?

Family Size

Full-name and Birthdate

Parent A is

Parent B is

Household's Gross Monthly Income (income before taxes)*

Income Source (i.e. employment, CalWORKS, child support, etc.)*

Please check the center(s) you prefer:

Early Learning Center, San Mateo (3 months to 5 years)
First Step CDC, San Mateo (18 months to 5 years)
Haven CDC, Menlo Park (18 months to 5 years)
Leo J. Ryan CDC, South San Francisco (3 to 5 years)
Club Leo J. Ryan, South San Francisco (5 to 12 years)
Mission CDC, Daly City (3 months to 3 years)
87th Street CDC, Daly City (3 to 5 years)
Midway CDC, Daly City (3 months to 5 years)
Our Second Home CDC, Daly City (3 to 5 years)