Membership Application

Name: ________________________________________________

Phone Number: _________________________________________

Cell Phone: ______________________________________________

Address: ________________________________________________

City: ___________________________

State: ___________ Zip: ________

Email Address: ______________________________________________

______ I would like to have meeting and business info emailed to me

_____ Please do not email me


______ New Membership $50

(We need a copy of your license)

______ Renewal of Membership $50

(We need a copy of your cancelled check from licensing)

Capacity: ______ 8 . .or . . ______ 14

______ Childcare Advocate $25

______ Student $25

______ Corporate Member (includes advertising in newsletter) $150 and up

We need your help! Please check one or more of the following:

_____ I would like to bring refreshments to a meeting

_____ I would like to be a greeter at a meeting

_____ I would like to help at a fundraiser

_____ I would like to be on a committee

I’m interested in _____________________

I can help with:

_____ Making photocopies

_____ Donating door prizes

_____ Other

Send check payable to: FDCASCV, P.O. Box 802232, Santa Clarita, CA 91380-2232

Please allow 3 to 4 weeks processing time.

Members who are more than 30 days late in paying their renewal membership fees will be taken off the next referral list until paid.

You will still need to mail in the form above

Licensed Child Care Provider

$50 per year + $2.00 service charge


Child Care Advocate

$25 per year + $2.00 service charge