Enrollment

Interest Form

Recruitment Form for David Kanis Child Development Center. Please fill out this form and we will get in touch with you shortly.

If you see this don't fill out this input box.

Child

*Which program are you applying for:

Pre-K (3-5 years old)Evening Care (Kindergarten - 12 years old) CSU Students Only

*Interested in Enrolling:

*First Name:

*Last Name:

*Birth Date

*Primary Language

Parent/Guardian

*First Name

*Last Name

*Address

*City

*State

*Zipcode

*Phone

*Email Address:

The student parent act requires CSU to disclose this information.

*Number of children belonging to currenty enrolled CSU students