Emergency Child Care Program INTEREST FORM (INACTIVE)

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PLEASE VISIT REG.LAPARKS.ORG TO REGISTER FOR OUR SUMMER PLAY L.A. PROGRAM. THE ECCP PROGRAM IS NO LONGER ACTIVE.

THIS PROGRAM IS ONLY FOR HOSPITAL WORKERS AND LA CITY EMERGENCY RESPONDERS. THIS FORM MUST BE COMPLETED AND SUBMITTED TO RECEIVE REGISTRATION ACCESS. (ESTE FORMULARIO DEBE COMPLETARSE POR EL TRABAJADOR DE SALUD Y DEBE COMPLETARSE ANTES DE LA LLEGADA AL CENTRO DE CUIDADO INFANTIL.)

Email *

Primary Phone Number (Número de teléfono principal) *

Parent/Guardian Full Name (Nombre completo del padre/tutor) *

If You're A Hospital Worker Please List Your Hospital Work Location (Ubicación de trabajo en el hospital) - Type N/A if Not Applicable *

Please list the name of the hospital where you are currently employed. (Indique el nombre del hospital en el que está empleado actualmente)

Only If You're A Los Angeles City Emergency Responder Please List Your Department Name (Nombre de Departamento) - Type N/A if Not Applicable *

Please list the City Department of which you currently work. Examples include LAPD, POLA, LAWA, RAP Staff and sworn officers.

PLEASE SELECT ONE : Civil Service Job Classification & Description (Clasificación de trabajo del servicio civil)

Name of Child(ren) (Nombre de niño/s) *

Child(ren)'s Age Group (Grupo de edad del niño(s))

Select

6 -8 years old (años)

9 - 10 years old (años)

11 - 14 years old (años)

Clear selection

Desired Childcare Location (Ubicación de cuidado de niños deseada) *

Please make your 1st and 2nd selection below. We will do our best to accommodate your preferred location. (Por favor, de elegir su 1a y 2a selección. Haremos todo lo posible para acomodar su ubicación preferida

Barrington Recreation Center - 333 S. Barrington Ave., Los Angeles, CA 90049

Eagle Rock Recreation Center - 1100 Eagle Vista Dr, Los Angeles, CA 90041

Evergreen Child Care Center - 211 S. Evergreen Ave. Los Angeles, CA 90033

EXPO Child Care Center - 3980 Bill Robertson Ln, Los Angeles, CA 90037

Lemon Grove Recreation Center - 4959 Lemon Grove Ave, Los Angeles, CA 90029

Penmar Recreation Center - 1341 Lake St., Venice, CA 90291

Sylmar Recreation Center - 13109 Borden Ave, Sylmar, CA 91342

Tarzana Childcare Center - 5655 Vanalden Ave., Tarzana, CA 91356

Winnetka Recreation Center - 8401 Winnetka Ave., Winnetka, CA 91306

Glassell Recreation Center - 3650 Verdugo Road., Los Angeles CA 90065

Victory Vineland Recreation Center - 11117 Victory Blvd., North Hollywood, CA 91606

Yucca Recreation Center - 6671 Yucca Street, Hollywood, 90028

Palms Recreation Center - 2950 Overland Ave., Los Angeles 90064

Fernangeles Recreation Center - 8851 Laurel Canyon Blvd., Sun Valley, 91352

Loren Miller Recreation Center - 2717 Halldale Ave., Los Angeles, 90018

Vineyard Recreation Center - 2942 Vineyard Ave., Los Angeles, 90016

Lanark Recreation Center - 21816 Lanark Street, Canoga, 91304

Banning Recreation Center - 1331 Eubank Ave., Wilmington, 90744

Required

Desired Childcare Days (Monday - Friday) (Días de cuidado infantil deseados (Lunes - Viernes)

Once program begins MONTHLY registration is required. Please select a DROP OFF and PICK UP TIME for each day. (use the scroll bar to access additional times) (Una vez que el programa comienza se requiere registrarse MENSUALMENTE. Por cada día, por favor seleccione el tiempo para DEJAR Y RECOGER) (utilizar la barra de desplazamiento para acceder a los tiempos adicionales)

6am

7am

8am

9am

10am

11am

12pm

1pm

2pm

3pm

4pm

5pm

6pm

Monday (Lunes)

Tuesday (Martes)

Wednesday (Miércoles)

Thursday (Jueves)

Friday (Viernes)

Preferred Start Date *

A start date confirmation will be emailed once registration is completed. (Una vez que se complete el registro, se enviará una confirmación de la fecha de inicio.)

Questions and comments (Preguntas y comentarios)

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