EmailMe Form - Homebase

Child's Name *

First Last

Current Grade *

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

As of Jan we have Mon , Thur and Fridays

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 Winter '25

List: Mon, Tues, Wed, Thur, Fri

Sibling 2 Name

First Last

Days Requesting for Winter '25

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.