EmailMeForm
Homebase
WAITLIST
Child's Name
*
First
Last
Birthday
*
Gender
female
male
non-binary
When would you like to enroll your child?
*
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
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
NEW FAMILY REGISTRATION REQUEST (Current Families Scroll Down)
Note: Enrollment is based on space availability and is not guaranteed. You will be notified by the end of the school year it we can accommodate your request
Days Requesting
Please put me on wait list
yes
no
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 1 Name
First
Last
Days Requesting for Fall '23
List: Mon, Tues, Wed, Thur, Fri
Sibling 2 Name
First
Last
Days Requesting for Fall '23
List: Mon, Tues, Wed, Thur, Fri
FAMILY INFORMATION
Parent's Name
*
First
Last
Email
*
Phone
###
-
###
-
####
ALMOST THERE....
Signature
*
Clear
Your signature indicates agreement to our registration terms for the Fall 2022 After School Program Session for HOMEBASE at Kid 'N Dance.
Printed Name
*
First and Last Name of person that completed the form and signed above.
