Extended Student Services (ESS) Wait List Form

ESS Family Information and Waitlist Form

Please complete the form below. As space becomes available, a program coordinator will contact you.

Primary Family Email Address

Preferred Language

Address

City

State/Province

Zip Code

Parent 1

Mother's Name

Mother's Email Address (if different from the Primary email address)

Mother's Primary Phone

Mother's Secondary Phone

Parent 2

Father's Name

Father's Email Address (if different from the Primary email address)

Father's Primary Phone

Father's Secondary Phone

Please list all children below:

Child #1

Child #1 Name (required)

Child #1 Birth Date (required)

Child #1 Year Starting (required)

Child #1 Grade (required)

Child #1 Home School (Select 1) (required)

Child #2

Child #2 Name

Child #2 Birth Date

Child #2 Year Starting

Child #2 Grade

Child #2 Home School (Select 1)

Child #3

Child #3 Name

Child #3 Birth Date

Child #3 Year Starting

Child #3 Grade

Child #3 Home School (Select 1)

Child #4

Child #4 Name

Child #4 Birth Date

Child #4 Year Starting

Child #4 Grade

Child #4 Home School (Select 1)

General Information

Is your child already attending an LVJUSD school?

Yes

Do you think you qualify for subsidy assistance?

Yes

Tuition assistance is based on a sliding scale.

If you feel you may be eligible for tuition assistance, please indicate your total gross family monthly income

If you feel you may be eligible for tuition assistance, please indicate you family size: #Adults/#Children

Comments or Questions

Your application will be dated upon receipt and you will be contacted when there is an opening at your home school site or the school your student is currently enrolled in.

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Website Accessibility Policy

Livermore Area Recreation and Park District is fully committed to providing accessible facilities, elements and channels of communication to all members of the public. As part of this commitment, Livermore Area Recreation and Park District has a policy of providing an accessible website compatible with the Web Content Accessibility Guidelines (WCAG 2.1) and commercial screen reading software. All features of the website are coded to allow individuals with vision and other impairments to understand and use the website to the same degree as someone without disabilities. We welcome feedback and can often resolve issues in a timely manner if they arise.

If you need any special assistance or accommodations:

Call us at 925-373-5700 | HOURS: M-F 9a-5p

Ongoing Compliance Information

Compliance Officer

Livermore Area Recreation and Park District has designated a compliance officer for website disability-related accommodations. The compliance officer has received training in website accessibility and updates the site in accordance with those best practices. Contact our accessibility officer to report an issue.

Compliance Procedures and Reports

In addition to testing with users with a wide range of disabilities and coding our website to WCAG standards, Livermore Area Recreation and Park District regularly scans its website to ensure ongoing compliance, and makes timely changes to any inaccessible changes, if any are found.

Linked Documents and Third Parties

Please note that this site may link out to third-party websites, such as state or federal agencies, that do not have accessible content. This site may also include documents provided by third parties included in our agenda packets, for example. While we cannot control the accessibility of content provided by third parties, we are happy to assist any member of the public with reading and accessing content on our site.

See an opportunity for us to improve? Please contact our accessibility officer or call us at 925-373-5700 | HOURS: M-F 9a-5p.

Report a Website Accessibility Issue

We are committed to your ability to access all content, and we will respond to all requests as soon as possible.