Resource And Referral - Waiting List Continuation Form
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1RESOURCE AND REFERRAL
WAITING LIST CONTINUATION FORM
PARENTS INFORMATION
TELEPHONE NUMBERS PLEASE LIST BEST CONTACT
NUMBER(S)
SPONSOR’S
HOME/CELL
UNIT & RANK
PHONE #
SPONSOR’S
SPONSOR’S
NAME
WORK #
PARENT/SPOUSE
PARENT OR
NAME
SPOUSE
WORK #
STREET
PARENT/SPOUSE
ADDRESS
UNIT & RANK
(
IF APPLICABLE)
CITY, STATE &
CHILD’S
ZIP
NAME
EMAIL ADDRESS:__________________________________________________________________________________________
SPONSOR STATUS: ___MARRIED
___DIVORCED _____SINGLE NEVER MARRIED
(IF DIVORCED/SINGLE NEVER MARRIED CUSTODY DOCUMENTS WILL NEED TO BE PROVIDED)
DOES SPONSOR HAVE CUSTODY ARRANGEMENTS? YES
NO (CUSTODY DOCUMENTS MAY BE REQUIRED)
IS PARENT/ SPOUSE WORKING 30 OR MORE HOURS PER WEEK OR IN SCHOOL FULLTIME?
YES
NO
PLACE OF EMPLOYMENT/SCHOOL NAME:
_________________________________________________________________________
(You must provide a current pay stub to show fulltime employment status. Full time students must provide proof of registration; showing
courses and fees are paid in full each semester)
ARE YOU CURRENTLY RECEIVING NACCRRA/CHILD CARE AWARE SERVICES?
YES
NO
IF YES, PLEASE LIST THE FACILITY OR NAME OF PROVIDER YOU ARE USING_______________________________
CENTER CHOICE(S):
YOU MAY CHECK MORE THAN 1 HOWEVER WHATEVER BECOMES AVAILABLE FIRST THAT IS THE
ONE YOU WILL RECEIVE IF YOU DECLINE THAT SPOT YOU WILL BE TAKEN OFF THE WAITLIST.
CHECK
CENTER
LOCATION
CHILDREN AGES
NEAR THE MAIN GATE
6 WEEKS-5 YEARS
BROWNE CDC
COURTEAU CDC
BEHIND JOHNNY ROCKETS (MAIN SIDE)
6 WEEKS - 5 YEARS
FISHER CHILDREN’S CENTER
ACROSS FROM WARD LODGING
TODDLER AND
PART DAY IS FOR 2-4 YEAR OLDS
PRESCHOOL PART DAY
DELUZ CDC
DELUZ HOUSING (MAIN SIDE)
6 WEEKS-KINDER
STUART MESA HOUSING
6 WEEKS – 1 ST GRADE
STUART MESA CDC
SAN LUIS REY CDC
NEAR BASE STABLES (BACK GATE IN
PRESCHOOL PART DAY,
PART DAY IS FOR 3-4 YEAR OLDS
OFFICER HOUSING)
KINDER AND 6TH GRADE
SAN ONOFRE CDC
SEASIDE SQUARE (San Onofre Gate)
6 WEEKS – 6th GRADE
SAN RAFAEL CDC
MAIN GATE NEAR NORTH TERRACE
6 WEEKS – PRESCHOOL
ELEMENTARY SCHOOL
SCHOOL AGE CARE
(SAC PROGRAM)
GRADES
MARY FAY PENDLETON
SAN LUIS REY CDC
KINDER-6 TH GRADE
NORTH TERRACE SAC
NORTH TERRACE ELEMENTARY SCHOOL
KINDER- 6 TH GRADE
SANTA MARGARITA SAC
SANTA MARGARITA ELEMENTARY SCHOOL
KINDER- 6 TH GRADE
STUART MESA SAC
STUART MESA ELEMENTARY SCHOOL
2 ND GRADE- 6 TH GRADE
*THREE YEAR OLDS MUST BE FULLY POTTY TRAINED, MEANING THE CHILD CAN TELL THE CAREGIVER THAT THEY
HAVE TO GO TO THE REST ROOM & THE CHILD IS NOT IN PULL-UPS OR DIAPERS.*
PARENT SIGNATURE: ________________________________________
DATE: ___________________
YOU MUST UPDATE EVERY 90 DAYS TO STAY ACTIVE ON THE WAITING LIST
YOU MAY MAKE COPIES FOR FUTURE USE
*FAX 760-725-7097*
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