Application

Valdivia Family Day Care has year round enrollment. Only up to two-three children enrolled at a time. My hours and days open are 8:30am to 4:30pm Monday through Thursday.

Filling out the application and paying the non-refundable application fee does not guarantee a child care slot. If there is not an opening available you will be put on the wait list. Sending in the application guarantees you will be contacted to interview if a slot becomes available in the time frame you are looking for care. If an opening does become available I will ask that you send in the application fee at that time and we will schedule the phone interview which is the first step in the interview process once your application fee is received. If there is an opening at the time you send in your application and family photo, the application fee of $40.00 should accompany both.

VALDIVIA FAMILY DAY CARE APPLICATION FOR ENROLLMENT

Student Information:

Date of Birth:______________________Sex__________________

Date you wish to enroll your child:

__________________________________________________

Today's date:____________________________________________

Your Child's Full Name__________________________________________________

Last First Middle and Nickname

Child's Address________________________________________________

Primary Hours of Care needed:

From_________________________To_____________________ (program opens at 8:30am and closes at 4:30pm)(days open M-Th)

*******************FamilyInformation:***************

Child Lives with:

______________________________________________

Parents Name:_________________________________________________

Parents Name___________________________________________________

Address:___________________________________________

Home Phone:________________________________________________

Home Phone_________________________________________________

Email:____________________________________________

Email_____________________________________________

Employer:_________________________________________

Employer__________________________________________

Address:__________________________________________

Phone:____________________________________________

Phone:___________________________________________

Cell Phone:________________________________________________

Please list allergies, special medical or dietary needs, or other areas of concern

____________________________________________________

___________________________________________________

__________________________________________________

Are you looking for temporary or long term care?

____________________________________________________

Definition of temporary care is less than a year. Definition of long term is up to 2.9 years.

*A $40.00 non-refundable application fee and a photo of you and your child (family photo) must accompany your application(only when an opening is available, otherwise please just send in the application and family photo.) If an opening does become available I will contact you to see if you are still in need of care and at that time I will have you send the application fee prior to the phone interview. Applying and sending in the $40.00 non-refundable fee does not guarantee slot availability! Please write the check to Lucille Valdivia. Thank you!

Child care slots are full time and part time depending on availability only. Sorry no drop ins accepted. Ratio is 2:1. Hours that Valdivia Family Day Care is open: 8:30am to 4:30pm. Days open are Monday-Thursday. Organic snacks are served. Parents supply lunch for children 1 year to 2 years 9 months and both AM and PM snack with lunch for children 3 months to 1 year. No child will be denied admission on the basis of race, religion or a special need. Children who have special needs or challenges will be accepted if it is determined that I, Lucille Valdivia, Owner of Valdivia Family Day Care, am able to meet their individual needs and those of the other children enrolled in Valdivia Family Day Care.

Custody: Mother(s) Father(s) Both Other

(Specify):____________________________Please circle:
Helpful Information about Child:

Has your child ever attended group care before:

____________________________________________________

Which type of program best describes your child's experience?

Family Day Care Co-op care Center based program Nanny Nanny share Stayed at home with parent Please circle:

Please tell me a little about your child:

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

____________________________________________________

Please note that Family Child Care is subjected to the same or similar regulations as Center based care or K-12th grade education in the State of California. There are forms that must be on file including but not limited to: Policy and Procedure Contract; Illness Policy; Consent for emergency medical treatment; Immunization Requirements; Child's Needs and Services Plan; and other licensing forms. These forms must be filled out prior to your child beginning care at Valdivia Family Day Care. Filling out the application does not guarantee a slot for your child.

Thank you for your application for enrollment. The interview is a three step process as follows:

Fill out and send in application. Please note, only send in the application fee of $40.00 if after contacting me or my web page states there is an opening available.

1.)Once I receive your application I will contact you to schedule a phone interview within 7 working days( please see note below). Only if an opening is available, if an opening is not available I will contact you to inform you that I have received your application and will put your application in a wait list file according to the month you are looking for care. I will not contact you unless an opening becomes available in the time frame you list on your application. During the interview we will go over any questions you have. I will also ask you some questions. We will then schedule an in-house interview.

3.)3rd step of the interview process. In-house interviews are conducted from 5:00pm to 5:30pm (times may change in the future). After the in-house interview there may be an additional 15 minute observation at 8:30am, days vary.

NOTE: After receiving the application I will contact you within 7 working days. Please be aware that there are times in the year that I may be closed of 1-2 weeks. If this is the case and you do not hear from me in 7 buisness/working days please be patient. I will contact within 7 business days once I return to work.

Lucille M. Valdivia

Valdivia Family Day

1227 Hampshire Street #43

San Francisco, Ca. 94110

415-285-2838wk

Lic: 384000643

Please send completed application to the above address.