Interest Form 2022-2023

The Skill Builder’s after-school program provides care for children with special needs in the Coachella Valley. The program operates twice per week during after-school hours for participants ages 7 to 22.
Participants must be able to safely participate in a small group without 1:1 support. 

If interested in enrolling your child, please complete the interest form below. We currently have 3 after-school programs open located in two different cities. Our West Valley program operates Monday & Tuesdays in Cathedral City. The Mid Valley Program operates Wednesdays & Thursdays in Palm Desert. Lastly, the East Valley program operates Monday & Tuesdays in Palm Desert. 

Transportation to the program is not guaranteed. Families may need to drop off participants based on their child's school bell schedule and/ or location. 

NOTICE: We want to clarify that the submission of this form does not confirm your child is enrolled in the program.

This form will add your child to the interest list. A formal intake and enrollment process will follow in the order the interest form was received. Completing this interest form will help us to determine the need for additional programs and locations.  We appreciate your interest and thank you for taking the time to complete the form below. 

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* 1. What is your name? (Parent/ Guardian).  Nombre del Padre o Guardian

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* 2. Phone number/ Numero de telefono

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* 3. What's your address?/ Cual es su domicilio?

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* 4. E-mail/ Correo Electronico

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* 5. Primary Language/ Lenguaje 

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* 6. What is your child's name and last name?/ Nombre y apellido del Niño(a)?

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* 7. What school district does your child currently attend? / A que Distrito escolar asiste su hijo(a).

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* 8. What school does your child attend for the  2022-2023 school year? / A que escuela asiste su hijo(a) en el año escolar 2022-2023?

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* 9. Which projected location would you like your child to attend?/ ¿A qué lugar proyectado le gustaría que asistiera su hijo?

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* 10. At what time will your child get out from school in the 2022-2023 school year? / A que hora su hijo(a) saldra de la escuela en el año escolar 2022-2023

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* 11. Has your child been vaccinated against COVID-19? Su ñino(a) esta vacunado contra el COVID?

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* 12. We currently offer an after school Virtual Program. Would you be interested in your child participating in the virtual zoom activities this summer? /Actualmente ofrecemos un programa virtual después de la escuela. ¿Le interesaría que su hijo participara en las actividades virtuales de zoom este verano?

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* 13. I understand that by completing this form, it does not guarantee my child(ren) placement into the afterschool program. / Entiendo que completar este formulario no garantiza la ubicación de mi(s) hijo(s) en el programa extracurricular.

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