TLC Palega Recreation Center

San Francisco Recreation and Park Department's Tennis and Learning Center at Palega Recreation Center
Parent/Guardian Information:
Parent/Guardian 1

First NameLast Name
Home Address:
Email:
example@example.com
Preferred Phone #:
Relationship to Child:
Highest Education Level:
Preferred Language:
Parent/Guardian 2

First NameLast Name
Home Address:
Email:
example@example.com
Preferred Phone #:
Relationship to Child:
Highest Education Level:
Preferred Language:

Applicant's Information:
Child's Full Name:

First NameLast Name
Birth date:

MonthDayYear
Gender:
Ethnicity:
Grade for Academic Year 2024-25:
School:
Preferred Language:
Does this child currently have an Individualized Education Plan IEP or is he/she designated as special education at school?*
Does your child have any medical conditions?*
If yes, please explain:*
Please complete for any additional applicants:*
Child's Full Name:

First NameLast Name
Birth date:

MonthDayYear
Date
Gender:
Ethnicity:
Grade for Academic Year 2024-25:
School :
Preferred Language:
Does this child currently have an Individualized Education Plan IEP or is he/she designated as special education at school?*
Does your child have any medical conditions?*
If yes, please explain:*

Does your child (ren) qualify for the free or reduced lunch program?*
Questionnaire:
1. What academic and social goals do you have for your child? Please be as specific as possible.*
2. What are your child's strengths and challenges?*
3. What would you like your child to gain from the TLC program?*
4. Will your child play afterschool sports or participate in other afterschool programs? *
If Yes, please explain.*
5. Parents/guardians are required to participate in TLC by establishing academic goals for your child and communicating on the progress of those goals with TLC staff will also have to attend 3 parent workshops a year are you willing to be an active participant?*

YesNo
6. Is there anything else you'd like us to know about your child or your circumstances?*
*For more information, email Channing Hale at channing.hale@sfgov.org or mail it to: San Francisco Recreation and Parks Department, 500 Felton Street, San Francisco, CA 94104
Should be Empty: