CCPPNS - Parent Involvement in Child's Education

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Area:
Council:
*Phone:	xxx-xxx-xxxx
School Contact Email:	This email address should be the main contact email for the school.
*Your Email:	We will be sending a confirmation of the renewal of membership to this email address. Please make sure this email is YOUR address or the address of where you would like the confirmation to be sent to.
School Information
School Name:
*Address:
Mailing Address:	If different from above address
*City:
*State:
*Zip:
License & Insurance Information
California Council requires its members be licensed or fall under the jurisdiction of a school district, city or county.
*License Type:		Expiration:
California Council requests the following information for our records:
Liablity Insurance:		*Expiration:	YYYY/MM/DD
Student Accident Insurance:		*Expiration:	YYYY/MM/DD
Program Information
*Number of families:
*Number of children:
Maximum number of children allowed:
*Classes available:		For example: MWF 9-12 3yr olds







I certify that the above information is correct.
*Director's Name:

*Please select which method you will be using to submit membership renewal fees:
	Check
	Credit Card
	If paying by credit card please enter the first and last name of the person as it appears on the credit card and which school the payment is for. i.e. Fred Flinstone for Bedrock Preschool

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