Children's Center School Age Program Waiting List Form
Please fill out the form completely. A separate form is required per child. Please click on submit at the bottom in order to submit the completed form.

Thank you for your interest in our School Age Before and After School Program at SRSRC Children's Center.

The completion of this form does not guarantee or confirm your participation or a spot in our program. This form is to place your child's name on the waiting/interest list. We will contact you with information once a spot becomes available. Priority enrollment is given to current program participants, siblings of current participants, members, and then non-members. Although we would love to accommodate all requests, space within our program is limited. We appreciate your understanding.
Parent/Guardian Name: *
Your answer
Parent/Guardian Email: *
Your answer
Parent/Guardian Phone Number: *
Your answer
Additional Parent/Guardian Name:
Your answer
Additional Parent/Guardian Email:
Your answer
Additional Parent/Guardian Phone Number:
Your answer
Are you a member of Scripps Ranch Swim and Racquet Club? *
If you are a member, please enter your member number.
Your answer
If you are not a member, are you currently on the membership waiting list?
School Child Attends / Will Attend *
Please note that the Children's Center School Age Program is limited to Jerabek Elementary School students.
Child's Name: *
Your answer
Child's Current Grade: *
Select the school year that you are interested in beginning enrollment for your child. *
Please select the program options for which you are interested in enrolling your child. *
Required
Is your child a current participant in one of our school programs? Please select the program.
Priority registration is given to All Around Fun before/after school program, Children's Center programs, and Adventure Park program current participants.
Does your child currently have a sibling enrolled in the Children's Center School Age Program or Children's Center Preschool?
Submit
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