EmailMe Form - 2026 FALL HOMEBASE INTEREST

Child's Name *

First Last

Grade Starting in Fall '26 *

Gender

female

male

non-binary

Does your child have any medical, behavioral, sensory, emotional, or learning needs that would be helpful for us to know about?

We make a special effort to create a safe, inclusive, and welcoming community for all. *

(Examples may include ADHD, autism, anxiety, sensory sensitivities, learning disabilities, or other considerations.)

When would you like to enroll?

FALL 2026

Sibling Request

Does not apply

We would like to enroll siblings

Sibling info to be added later

School *

Redwood Heights Elementary

Crocker Highlands Elementary

Other - Transportation is not provided

List your school if NOT Crocker or RHS

For students NOT at Crocker or Redwood Heights *

Does not apply

I understand that I would have to provide my own transportation and earliest drop off time M, T, TH, Fr is 3:00 and on W it is 1:30

Days Requesting - List all you are interested in even if they are not shown as available

Space Available Monday & Friday
NOTE: It is challenging to get 5 days a week or Wednesdays as a new student. Most have to build up to it. Once in the program, you have the opportunity to take advantage of new opening before offered to those on the waitlist.

Can your days of the week be flexible? *

Yes - I'll take what I can get

Somewhat - I have some limitations (explained below)

No - I need specific days

We are not asking if you can change your days from week to week. We are asking if the regular schedule you are choosing is flexible.

Explanation of Flexibility

Example: "I need three days a week. I can be flexible for 2 days but need Fridays"

SIBLING ENROLLMENT REQUEST

SIBLING Name

First Last

FALL '26 Grade SIBLING *

Gender SIBLING

female

male

non-binary

Does the sibling above have any medical, behavioral, sensory, emotional, or learning needs that would be helpful for us to know about?

We make a special effort to create a safe, inclusive, and welcoming community for all. *

(Examples may include ADHD, autism, anxiety, sensory sensitivities, learning disabilities, or other considerations.)

Scheduling Siblings

Sibling days need to be the same

Siblings can have different schedules

FAMILY INFORMATION

Parent's Name *

First Last

Email *

Phone

### - ### - ####

Questions, Comments,
Clarifications:

ALMOST THERE....

Printed Name *

First and Last Name of person that completed the form and signed above.