Enrollment Application

Please select the location that you wish to enroll your child

4115 Jacksol Drive, San Jose
831 Malone Road, San Jose

Program Enrollment (Please select one)

Full Day w/ Extended Care (5 days per week, before 8am and/or after 5pm)
Full Day (5 days per week, 8am-5pm)
Full Day x3 (3 days per week, 8am-5pm)
Half Day (5 days per week, 8am-12:00pm)
Full Day x2 (2 days per week, 8am-5pm)
Half Day x3 (3 days per week, 8am-12:00pm)

Child’s Information

Parent/Guardian Information





Emergency Information

Names, Addresses and Phone Numbers of two (2) people to contact if parents CANNOT be reached

Attach legal documents (Optional)

Application Fees

For this application to be processed, a $40 application fee must be paid. A payment link will be emailed to you within 24 hours after on-line submittal.

Agreements

1. Learning Pathways agrees to notify the parent/guardian whenever the child becomes ill and the parent/guardian will arrange to have the child picked up as soon as possible if so requested by the center.

2. The parent/guardian authorizes Learning Pathways to obtain immediate medical care if any emergency occurs when he/she cannot be located immediately.*

NOTE: If there is an objection to seeking emergency care, a statement should be obtained from the parents or guardian that states their objection and the reason for their objection.
3. The parent/guardian agrees to Learning Pathways’ rules and regulations as described in the policy guidelines found in the Parent Handbook (provided).

4. The parent/guardian agrees to inform Learning Pathways within 24 hours or the next business day after his/her child or any member of the immediate household has developed a reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately.

Proof of the child’s identity and age may include a certified copy of the child’s birth certificate, birth registration card, notification of birth (hospital, physician or midwife record), a passport, a copy of the placement agreement or other proof of the child’s identity from a child placing agency or a certification by a director of a school in the U.S. that a certified copy of the child’s birth record that was previously presented. While Learning Pathways is not required to keep proof of the child’s identity, documentation of viewing this information must be maintained for each child.