Old Intent

INTERESTED IN ENROLLING?
Fill the following out to get started:

Please complete this form only AFTER you have toured our facility.

Harmon Oaks will not share your personal information with any third party. We will ONLY use the information you provide to establish initial contact with your family.

* Indicates required field

Parent *

First

Last

Email *

Parent *

First

Last

Email *

Primary Phone Number *

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent 1 - Profession / Place of Work *

Parent 2 - Profession / Place of Work *

Child's Name *

First

Last

Program of Need: *

Family Need: *

I would be willing to enroll my child full-time, should a part time seat not be available? I'd like to be on the waitlist for both options. *

Child's Date of Birth *

Preferred Start Date: *

Location/Facility of Interest *

Harmon Oaks Lake Balboa Harmon Oaks NoHo West First Available- Lake Balboa & NoHo West

How is your child cared for presently? If in a center or daycare, please name/where presently enrolled. *

Briefly explain why you are looking to begin/change your child's day setting? *

Describe your little one to us in one paragraph. Tell us about his/her "loves" and interests, personality, as well as, temperament and relationship with family members at home. You may be as brief or as thorough as you wish. *

Questions or further information you'd like to share with us (CCRC support, lunch program, special needs, dietary needs, etc.): *

How/why do you feel Harmon Oaks is the right fit for your family and for your child? *

Has your child experienced any developmental difficulties or delays (speech, gross motor skills, fine motor skills, language, physical impairments, emotional / social) which we would closely evaluate and support? *

Date Attended Open House and/or Tour: *

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INTERESTED IN ENROLLING?Fill the following out to get started:

INTERESTED IN ENROLLING?
Fill the following out to get started: