Children of Promise Early Learning Center Pre-Eligibility Registration

3130 W. 111th PL., Inglewood, California 90303
You MUST submit before leaving this form or ALL entries will be lost.

Parent or legal guardian #1

Household is a *

Parent or legal guardian #2

Reason for needing childcare

Check all that apply
Parent or guardian #1 *
Parent or guardian #2 *

CalWORKs participation (cash aid)

Currently receiving cash aid *
Received cash aid within last two years *
 +

Monthly income and sources: parent or guardian #1

Enter total dollars before taxes and deductions, for each source of income for parent or guardian in the household.

Monthly income and sources: parent or guardian #2

Enter total dollars before taxes and deductions, for each source of income for parent or guardian in the household.

Children living at home

List all children under 18 who are members of the family.
Are any members of your family school age children *
Gender *
 +
Child care needed *
Special Needs 🛈
 
Gender
 +
Child care needed
Special Needs 🛈
 
Gender
 +
Child care needed
Special Needs 🛈
 
Gender
 +
Child care needed
Special Needs 🛈
 
Gender
 +
Child care needed
Special Needs 🛈
 
Gender
 +
Child care needed
Special Needs 🛈
 

School age children