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Parent/Guardian Information

Your Full Name * (required)

Relationship to Child:

(please select below)MotherFatherFriendGrandparentOther RelativeGuardianOther

Your Email Address * (required)

Alternate Email Address

Telephone Number * (required)

Alternate Telephone Number:

Home Address * (required)

Your Employer * (required)

Employment Industry

Your Job Title

Your Work Number:

Child’s Information

Child’s First Name * (required)

Child’s Last Name * (required)

Child’s Date of Birth, Due Date, or Approximate Due Date * (required)

Gender of Child * (required)

(please select below)MaleFemaleUnknown

Desired Enrollment Date: * (required)

Number of Siblings:

(please select below)None123456789

Additional Information for a second parent/guardian (if applicable)

Partner’s Full Name

Partner’s Relationship to Child:

Partner’s Email Address

Partner’s Alternate Email Address

Partner’s Telephone Number:

Partner’s Employer

 
 

How did you become aware of C5 Children’s School?

Referral Source: * (required)

(please select below)Current C5 Enrolled FamilyFormer C5 Enrolled FamilyFriendCoworkerOnlineEmailPrint AdOther

Referral Code, if You Have One

Does your family have an Early Learning for All (ELFA) subsidy from the City of San Francisco?* (required)

YesNo

Once this form is complete, click Submit to proceed to payment of the application fee.