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Strides Day Program Information Request
Thank you for being so interested in the Strides program. Please submit your contact information, and we will be in touch about a tour of the program.
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* Indicates required question
Email
*
Your email
I understand that the applicant must be a Regional Center of the Easy Bay Client.
*
Yes
Required
I understand that attending a tour DOES NOT guarantee placement in the Strides program.
*
Yes
Required
I understand the waitlist for the Strides program could be up to three years.
*
Yes
Required
Last/First Name of Potential Strides Student
*
Your answer
Date of Birth
MM
/
DD
/
YYYY
Last/First Name of Caregiver
*
Your answer
Caregiver's Phone Number
*
Area Code + 7-digit number
Your answer
Caregiver's Email
*
Your answer
A copy of your responses will be emailed to the address you provided.
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