Thiebaut Method After School Program Application

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Please fill out this application for each child in the family who is applying for Thiebaut Method after school program enrollment. Please call us if you have any trouble filling out this form. 650-485-4877.

Today's Date / Fecha *

YYYY

Parent / Legal Guardian Name / Nombre del padre / tutor legal *

Relationship to Child You Are Applying For / Relación con el niño que está aplicando *

Phone number / Número de teléfono *

Email / Correo electrónico *

Home Address / Domicilio *

Family Annual Income / Ingresos anuales de familia *

Household Size / Tamaño de familia *

Child's Name / El nombre del niño *

Gender / Género (niño o niña) *

Male

Female

Prefer not to say

Ethnicity / Etnia / Raza *

Grade / Nivel de grado *

Current School Year (E.g. 2019-2020) / Año Escolar Actual (por ejemplo, 2019-2020) *

School / Escuela *

School District / Distrito Escolar *

Reason for Applying / Motivo de la solicitud *

How Did You Hear About Us? / ¿Cómo Te Enteraste De Nosotros? *

Option 1

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