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Name
First Last
Contact Phone
Alternate Phone
Contact Email
Address
Street Address City ZIP / Postal Code
Marital Status
Gender
Relationship to Child(ren)
Ethnicity
Child Age
I would like referrals to the closest*
- Child Care Centers
- Family Child Care Homes
I would like referrals to the following centers
Are you currently receiving cash aid or have you received cash aid in the last 24 months?
- Yes
- No
Reason for Needing Child Care*
- Actively Seeking Employment
- Incapacitated
- Seeking Permanent Housing
- No Need / Part Day Educational Preschool
- Education Or Training
- Protective Services
- Working
How did you hear about us?*
- Word of Mouth/ Friend told me
- Found through Online Search
- Instagram
- Facebook
- Twitter
- Previously Enrolled
- Other

Enrollment - CDCLA

CDCLA provides child care and development services throughout greater Los Angeles County. Our child care centers are located in Downtown Los Angeles, and more.

315 W 9th St Suite 500

Los Angeles

CA

90015

United States

213-244-1240

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