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If you would like to submit an application for either South of Market Child Care Center location, please fill out the form below. For subisidized child care, be sure to complete the lower portion. When completed, please print and mail, along with the required paperwork and a non refundable $50 application fee (fee is waved if you apply for subsidy), to the following address:

SOUTH OF MARKET CHILD CARE, Inc.
790 Folsom Street
San Francisco, CA 94107
Attn: Noushin Mofakham
Telephone (415) 820-3500
Fax (415) 820-3501

 

Application for: (check one)

Judith Baker Child Development Center

Yerba Buena Gardens Child Development Center

No Preference

 

Name of Parent/ Guardian:

Last Name:
First Name:
Street:
City:
State:

Zip Code:
Phone Number:
Fax Number:


Name of Parent/ Guardian:

Last Name:
First Name:
Street:
City:
State:

Zip Code:
Phone Number:
Fax Number:


Child Applying for:

Name of the Child:
Time (Hrs/days of the week):
Date of Birth:
Sex:
Ethnicity (optional):


Parent/ Guardian Employment Information:

Name of Employer:
Address of Employer:
City:
State:
Zip Code:
Phone Number:
Fax Number:


Parent/ Guardian Employment Information:

Name of Employer:
Address of Employer:
City:
State:
Zip Code:
Phone Number:
Fax Number:


Parent/ Guardian Training/School Information:

Name of School:
Street:
City:
State:
Zip Code:
Phone Number:
Fax Number:



Parent/ Guardian Training/School Information:

Name of School:
Street:
City:
State:
Zip Code:
Phone Number:
Fax Number:

 

All immunizations must be up to date before a child can be admitted.

If you are applying for subsidized child care please fill out the following section of the application:

Number of family members living in your household:
Adults:
Children:


Income Information:

Gross income from work:
TANF:
Other:
Total:

 

Need for child care (check all that apply)

Parent employed

Parent in Training

Seeking Employment

 Homeless

Parent incapacitated

Child with special need

 Child Protective Service or at risk of abuse or neglect

Please provide proof of income (attach to application).

 

If you have questions, please e-mail or call Judith Baker, Executive Director,
at (415) 820-3500.

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