Thank you for your interest in Kaiser Permanente Child Health Plan.
If your child resides in one of our Northern California service areas or in a Southern California county that is open to new enrollment and you would like to apply for membership, you may request an enrollment kit. Your enrollment kit will include all the forms you need to apply for coverage.
To request that a Child Health Plan enrollment kit be mailed to you:
Choose the appropriate link below for your region. Simply type your name and mailing address in the body of the email and send.
Note: Please do not change the subject line of the email.
Child Health Plan formsAccess and print the Child Health Plan application and other forms.