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2. The Town of Moraga is proud to present Remote Learning, Enrichment, & Childcare (REC) Club. This program will assist families in need of care during a regular school day. Town staff will proctor distance learning for students, provide opportunities for enrichment activities, and supervise outdoor recreation all within small stable cohorts.
4. REC Club will stay active during the distance learning and hybrid learning models. Participants in REC Club will receive priority registration for program extensions and changes in programming.
6. The program is available for anyone in need of distance learning support. Completed applications will be reviewed and a staff member will contact you about spots available.
   If spaces in the program are not currently available, you will receive a waiting list position number. Applications received after the initial application period will be added to the waiting list on a first come, first serve basis. It is our hope to expand the number of program cohorts as we hire additional staff. Completion of this application does not guarantee a spot in a program.
8. Please reference REC Club Information, Policies and Practices to read the most current program information from Parks and Recreation staff.
   REC Club Policies and Practices
10. DISCLAIMER: REC Club is not designed for high-risk individuals, or those who have family members who are high-risk. Please consult your healthcare professional for family specific recommendations before enrolling in REC Club should there be any questions or concerns.
12. Name*
14. Email Address*
15. Phone Number*
17. Address*
19. City*
20. State*
21. Zip Code*
23. Do both parents (or if single parent) work outside of the home?*

    1. Yes
    2. No
25. Is at least one parent an essential worker as defined by the state of California? *

    To see list of essential workers visit: https://covid19.ca.gov/essential-workforce/

    1. Yes
    2. No
27. Child 1
29. Name*
30. Date of Birth*
    Date of Birth
32. Grade*
    -- Select One --TKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
33. School*
    -- Select One --Donald Rheem Elementary Los Perales Elementary Camino Pablo ElementaryJoaquin Moraga IntermediateOther
35. What school does your child attend?
37. Child 2
39. Name
40. Date of Birth
    Date of Birth
42. Grade
    -- Select One --TKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade 6th Grade7th Grade8th Grade
43. School
    -- Select One --Camino Pablo ElementaryDonald Rheem Elementary Los Perales ElementaryJoaquin Moraga IntermediateOther
45. What school does your child attend?
47. Child 3
49. Name
50. Date of Birth
    Date of Birth
52. Grade
    -- Select One --TKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
53. School
    -- Select One --Camino Pablo ElementaryDonald Rheem Elementary Los Perales ElementaryJoaquin Moraga IntermediateOther
55. What school does your child attend?
57. Child 4
59. Name
60. Date of Birth
    Date of Birth
62. Grade
    -- Select One --TKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
63. School
    -- Select One --Camino Pablo Elementary Donald Rheem ElementaryLos Perales ElementaryJoaquin Moraga IntermediateOther
65. What school does your child attend?
67. Is there anything else we should know about your child(ren) or anticipated care needs?*
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69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

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