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Enrichment Program Interest Form

Please complete this form if you are interested in the Enrichment Program. Mandatory fields marked*

Submitting this form is not approval to begin care - please speak with an enrollment staff person. Allow at least 2 business days for a response, but feel free to call us at (626) 967-9337.

Student Name*

Answer Required

Date of Birth*

Answer Required

School Child is Attending*

Answer Required

Enrollment period requested:*

Answer Required

Current School Year

Summer Program

Upcoming/Next School Year

Parent Name*

Answer Required

Home Zip Code*

Answer Required

Daytime Phone Number*

Answer Required

Confirmation Email

Email Required