Pre-registration

Apply to La Peninsula.

Complete this short form to start your child’s enrollment. A family worker will follow up within 2 business days to schedule a visit and review required documents.

Child information

First name

Last name

Date of birth

Gender

My child has an IEP, IFSP, or developmental concern we should know about.

Parent / guardian

First name

Last name

Relationship to child

Phone number

Email address

Street address

Apt / floor

City

ZIP code

Household

Number of people in household

Annual household income

Primary language spoken at home

Program preferences

Center preference

Interested in

Head Start (ages 3–5)

Full-day classroom

Family services & workshops

Health & nutrition screenings

We need help with transportation to and from the center.

Other children in the family you may want to enroll

Anything else we should know?

Consent & signature

I agree that La Peninsula may contact me by phone, email, or text to follow up on this application.

I confirm that the information above is accurate to the best of my knowledge.

Type your full name to sign

View enrollment checklist