CASTRO VALLEY PARENT NURSERY SCHOOL
MEMBERSHIP APPLICATION
3657 Christensen Lane
Castro Valley, CA  94546
(510) 582-7731

The Castro Valley Parent Cooperative Nursery School is operated in conjunction with the Adult Education Department of Castro Valley Unified School District.


Application Date ______________________________

Child's Name _________________________________   Boy _____  Girl  _____

	Name child will use in school ___________________________________

	Age _____ years _____ months         Date of Birth __________________

Address _________________________________________________________

City __________________  Zip ____________  Phone # __________________

Email address ____________________________________________________

Mother's Name (first) _______________________ (last) ____________________

	Special Skills ________________________________________________

	Occupation ___________________  Place of business_______________

Father's Name (first) _______________________ (last) _____________________

	Special Skills ________________________________________________

	Occupation ___________________  Place of business_______________

Have you been in a cooperative preschool before?  ______ Yes  ______ No

If yes, name of school ______________________________________________

Parent Participation Day:  1st choice _____   2nd choice _____ 
  
	3rd choice _____

Where did you hear about the school? ____________________________________

I have read the attached requirements and understand them.


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