Parent Name:   

Mailing Address if different:
Primary Phone:
Email Address:
Verify Email:
Student Name:    
Birth Date:   
Race/Ethnicity: (Please check all that apply)
Hispanic or Latino Caucasian/White Black Asian American Indian or Alaskan Native Hawaiian or Pacific Islander
Has the student received part or full time services from Bay District Schools?
If yes, at which location: 
Please list (if any) the student's medical conditions and medications that we should be aware of:
Mother, Father, or student's guardian is employed by Bay District Schools
  Employee Id:
Zoned School:
I would like for my child to attend:
Reason for selection:
I plan for my child to only attend the VPK program, Monday through Friday (Times may differ by location).
I plan for my child to remain after the VPK program untiln the end of the regular school day at 2:00 pm. (Times may differ by location). I understand that the fee for this service is $60.00 per week.
*After 2:00 PM child care may be available at some school locations. Contcat Bay BASE at (850) 767-4066 to check availabilitiy.

School site availability is subject to change.

Parent's Online Signature:
Submit Application