1745 Copperhill Parkway Suite #5
Santa Rosa, CA 95403
BOARD OF DIRECTORS
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SUBSIDIZED Fall 2020 Enrollment Application
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EXTENDED CHILD CARE OF SONOMA COUNTY
1745 COPPERHILL PKWY, SUITE 5 SANTA ROSA CA 95403
TEL (707) 545-2402 FAX (707) 222-6233
**CURRENTLY ENROLLED SUBSIDIZED FAMILIES ONLY**
This application is ONLY for families that have a child enrolled in an ECC center.
Due to COVID-19, districts are moving toward a 100% distance learning model when school opens in August. All ECC centers will be open from 8:00 AM - 6:00 PM, Monday - Friday. Currently, the Sonoma County Health Ordinance limits child care to no more than 12 children per classroom.
SPACE IS EXTREMELY LIMITED
. Completing this form does not guarantee enrollment in our child care program.
We will be providing breakfast, lunch and snacks daily.
ECC is working with each district to ensure our staff have the necessary resources to support your child's Distance Learning while they are in care.
Indicates required field
Relationship to Child
Is your work considered "ESSENTIAL".
Does your employer allow for you to work from home or telecommute?
Please complete one application per child
Are there any special needs we need to be aware of?
If yes, please describe special needs:
Does you child have any severe allergies or medical conditions?
If yes, please explain:
Will medication be administered at the center?
CHILD CARE SCHEDULE NEEDED
3 day minimum required
DUE TO CURRENT RESTRICTIONS and LIMITED SPACE, 5 DAY PER WEEK SCHEDULES WILL BE THE HIGHEST PRIORITY.
Schedule per week needed
Check all that apply
Half Day Schedule (up to 6 hours)
Full Day Schedule (6.5 - 10 hours)
Please type your name.