Hayward Promise Neighborhoods Parent Academy
February 3 – April 7, 2025
Every Monday | 10:30 a.m. – 12:00 p.m.
9 weekly sessions
Virtual Class

ENGLISH SESSION

• Get together with other parents in your community to share how to raise healthy, happy children ages 0-8.
• Learn the different developmental stages of your children with the Abriendo Puertas/Opening Doors curriculum.
• Materials needed for class will be provided.

Earn a $100 grocery gift card when you complete the program!

SEE FLYER FOR MORE DETAILS HERE 

Name *

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Last

Phone Number

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Email Address *

Please indicate your preferred means of communication below. *

• Phone
• Email

Do you live in Hayward? *

• Yes
• No - If no, someone will contact you about eligibility.

Home Address: *

Address Line 1

Address Line 2

City

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How do you identify your race/ethnicity? Please select all that apply. *

• Black/African American
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If other, please enter race/ethnicity below. *

What is the primary language spoken in your home? *

How many people, including yourself, live in your home? *

Relationship to child(ren) *

# of Children *Select Answer123456

Child #1's Name *

First

Middle

Last

Child #1's Date of Birth *

Child #1's Age *

Child #1's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #1's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #1's race/ethnicity below. *

Child #1's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #1's school below. *

Does Child #1 have any allergies? *

• Yes
• No

If yes, please list Child #1's allergies below. *

Does Child #1 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #1's medical needs below. *

If Child #1 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #1? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #1? *

• Yes
• No

Child #2's Name *

First

Middle

Last

Child #2's Date of Birth *

Child #2's Age *

Child #2's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #2's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #2's race/ethnicity below. *

Child #2's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #2's school below. *

Does Child #2 have any allergies? *

• Yes
• No

If yes, please list Child #2's allergies below. *

Does Child #2 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #2's medical needs below. *

If Child #2 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #2? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #2? *

• Yes
• No

Child #3's Name *

First

Middle

Last

Child #3's Date of Birth *

Child #3's Age *

Child #3's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #3's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #3's race/ethnicity below. *

Child #3's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #3's school below. *

Does Child #3 have any allergies? *

• Yes
• No

If yes, please list Child #3's allergies below. *

Does Child #3 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #3's medical needs below. *

If Child #3 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #3? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #3? *

• Yes
• No

Child #4's Name *

First

Middle

Last

Child #4's Date of Birth *

Child #4's Age *

Child #4's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #4's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #4's race/ethnicity below. *

Child #4's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #4's school below. *

Does Child #4 have any allergies? *

• Yes
• No

If yes, please list Child #4's allergies below. *

Does Child #4 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #4's medical needs below. *

If Child #4 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #4? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #4? *

• Yes
• No

Child #5's Name *

First

Middle

Last

Child #5's Date of Birth *

Child #5's Age *

Child #5's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #5's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #5's race/ethnicity below. *

Child #5's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #5's school below. *

Does Child #5 have any allergies? *

• Yes
• No

If yes, please list Child #5's allergies below. *

Does Child #5 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #5's medical needs below. *

If Child #5 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #5? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #5? *

• Yes
• No

Child #6's Name *

First

Middle

Last

Child #6's Date of Birth *

Child #6's Age *

Child #6's Gender *

• Male
• Female
• Prefer not to say

How do you identify Child #6's race/ethnicity? Please select all that apply. *

• Black/African American
• White/Caucasian
• Alaskan or Native American
• Asian
• Hispanic/Latin
• Pacific islander
• Middle Eastern
• Prefer not to say
• Other

If other, please enter Child #6's race/ethnicity below. *

Child #6's School *Select AnswerBurbank ElementaryCherryland ElementaryEast Avenue ElementaryFairview ElementaryGlassbrook ElementaryHarder ElementaryRuus ElementaryTyrrell ElementaryBret Harte MiddleChavez MiddleBrenkwitz HighHayward HighTennyson HighOther

If other, please enter Child #6's school below. *

Does Child #6 have any allergies? *

• Yes
• No

If yes, please list Child #6's allergies below. *

Does Child #6 have any medical conditions we should know about? *

• Yes
• No

If yes, please describe how we can accommodate Child #6's medical needs below. *

If Child #6 is between the ages of 0 and 4 years old and in child care, please select their child care service(s):

• Full-day preschool or child care center
• Part-time preschool or child care center
• Licensed professional home-based provider
• Adult family member at child’s home
• Older sibling at child’s home
• Family, friend or neighbor’s home

Are you receiving any payment assistance to help pay for child care for Child #6? *

• Yes
• No

If no, would you like someone to call you with information about child care payment assistance for Child #6? *

• Yes
• No

Submit