Strides Day Program Information Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for being so interested in the Strides program. Please submit your contact information, and we will be in touch about a tour of the program.

Email *

I understand that the applicant must be a Regional Center of the Easy Bay Client. *

Yes

Required

I understand that attending a tour DOES NOT guarantee placement in the Strides program. *

Yes

Required

I understand the waitlist for the Strides program could be up to three years. *

Yes

Required

Last/First Name of Potential Strides Student *

Date of Birth

YYYY

Last/First Name of Caregiver *

Caregiver's Phone Number *

Area Code + 7-digit number

Caregiver's Email *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Castro Valley USD.

Does this form look suspicious? Report

Forms