Skip Main Navigation

Self-Pay Childcare Application

Parent Information
Type of Parent/Guardian
In Home?
Are you working?
Are you a student?
Child Information
Additional Children
I understand that it is my responsibility to notify AHC Childrens Lab School of any changes to the information on this application. Failure to report changes may be cause for removal of this application from the eligibility list. I agree that the information provided above is accurate and may be shared with other agencies in helping me receive childcare services.
Which location do you prefer?

Download PDF version of the Application

Descarge la solicitud Español

You also can fax the completed PDF application to: 1-805-922-6662 
or if you have any questions please call 1-805-922-6966 Ext. 3569