CHILDCARE REQUEST FORM
This request form is only for students who will need childcare assistance during their enrollment or during the school year in the Adult Education Center. Our childcare center can only accommodate 16 children at a time on a daily basis, this service is based on a first come and first serve basis. The childcare center does have a cost for it's usage to sustain the service. Childcare will cost $60.00 per regular (Spring and Fall) semester and $20.00 for Summer school. This fee is for any service during our school hours. (Please note: $20.00 for each additional child) NO EXCEPTIONS TO BE MADE.
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Email *
Child/Children's Information
Please provide your  Child/Children's information in the following questions.
How many children require childcare services? *
What is your child/ren's full name? *
What is your child/ren's birthdate's? *
What is/are the age of the child/ren who would like to attend the childcare center? We will only be offering this service for children between the ages of 2 years of age to 11 years. Child care is available for ages 2 - 5 in our morning sessions and ages 2 - 11 available for evening classes. Please write the name of the child/children next to the age *
Required
Parent's Information.
Parent's full name.
Parent's address? *
Parent's phone number? *
What program are you enrolling/enrolled in? *
Do you need childcare for the following? Please check all that apply.
Does your child/ren HAVE up to date shot records? (Please note up to date immunization records must be present in the main office before the child/ren can attend the child care center). Contact the main office for more information (707-453-6018). *
Does your child(ren) attend a school in Vacaville? If yes, what school do they attend and we can pull their shot records. (Write the name of the school down below)
I understand that my child cannot start in the childcare center without immunization records and that my child care fee of $60.00 must be paid in full. *
Do you need assistance with the childcare fee? *
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