Tax ID 94-3206278
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A Non-Profit 501(c)(3) Organization
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Nesbit Puma Cubs (Belmont)
Little Footsteps (San Mateo)
Redwood Creek (Redwood City)
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State Subsidized Child Care Waitlist Application Form
*
Indicates required field
Enrolling Child's Name
*
First
Last
Enrolling Child's Birthdate
*
Desired Start Date
*
Which location(s) are you interested in? (check all that apply)
*
Footsteps@Nesbit Puma Cubs (Belmont)
Little Footsteps (San Mateo)
Footsteps@Redwood Creek (Redwood City)
Footsteps@City Center Plaza (Redwood City) - August 2023
Number of Persons in Household
*
Number of Children under 18 years old in the household
*
Household Gross Monthly Income (Pre-Tax)
*
Does your family receive any governmental assistance?
*
No
Yes
Guardian 1 Name
*
First
Last
Guardian 2 Name
*
First
Last
Guardian 1 Email
*
Phone Number
*
Does Guardian 1 live with enrolling child?
*
Yes
No
Guardian 1 - Physical Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mailing Address same as Physical Address
*
Yes
No
Guardian 1 - Employment Status
*
Full Time (35+ hours per week)
Full Time (35+ hours per week) + Enrolled in a Training/School Program
Part-Time (less than 34 hours per week)
Part Time (less than 34 hours per week) + Enrolled in a Training/School Program
Enrolled in a Vocational Training or School Program
Seasonally Employed
Retired or Disabled
Unemployed and Seeking Employment
Guardian 2 Email
*
Phone Number
*
Does Guardian 2 live with enrolling child?
*
Yes
No
Guardian 2 - Physical Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mailing Address same as Physical Address
*
Yes
No
Guardian 2 - Employment Status
*
Full Time (35+ hours per week)
Full Time (35+ hours per week) + Enrolled in a Training/School
Part-Time (less than 34 hours per week)
Part Time (less than 34 hours per week) + Enrolled in aTraining/School
Seasonally Employed
Enrolled in a Vocational Training or School Program
Unemployed and Seeking Employment
Retired or Incapacitated
Work or School Schedule
*
SET Weekly Schedule
VARIABLE or ON-CALL Schedule
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
If SET weekly schedule, please provide start & end time per day. (example: 8am-5pm) If schedule is VARIABLE or ON-CALL, please mark all possible days of work
Earliest Start Time
*
Latest End Time
*
Request Travel Time
*
No
Yes
Not to exceed ½ daily hours worked, max 4 hours daily)
Request Sleep Time
*
No
Yes
Work hours and travel time between 10:00 PM and 6:00 AM
Work or School Schedule
*
SET Weekly Schedule
VARIABLE or ON CALL Schedule
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
If SET weekly schedule, please provide start & end time per day. (example: 8am-5pm) If schedule is VARIABLE or ON-CALL, please mark all possible days of work
Earliest Start Time
*
Latest End Time
*
Request Travel Time
*
No
Yes
Not to exceed ½ daily hours worked, max 4 hours daily)
Request Sleep Time
*
No
Yes
Work hours and travel time between 10:00 PM and 6:00 AM
Does your child need any accommodations or do you have any concerns about your child's development?
*
No
Yes
We will make every effort to include children with special needs in our program. Children who have special needs are considered for admission on an individual basis. The Site Director will meet with you before enrollment to determine if the program is the best environment for the child. Upon enrollment, staff and parents will meet regularly to monitor the child’s progress and discuss how best to support the child. It is sometimes necessary to redirect children and their families, especially if we do not have facilities or staff to work with the child’s needs. In these cases, the Site Director and the child’s parent or guardian will decide if the center can properly meet the needs of the child.
Does your child have an active IEP or IFSP?
*
No
Yes
We will make every effort to include children with special needs in our program. Children who have special needs are considered for admission on an individual basis. The Site Director will meet with you before enrollment to determine if the program is the best environment for the child. Upon enrollment, staff and parents will meet regularly to monitor the child’s progress and discuss how best to support the child. It is sometimes necessary to redirect children and their families, especially if we do not have facilities or staff to work with the child’s needs. In these cases, the Site Director and the child’s parent or guardian will decide if the center can properly meet the needs of the child.
Is there anything else you want to tell us about your child?
*
Note: Supporting Documentation will be required to verify family's eligibility
Submit
Registration Form
Please fill in the form below.
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