Waiting List Registration Form

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Waiting List Registration

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CHILDCARE CENTER
WAITING LIST INFORMATION FORM

NOTICE: Your child will be placed on the waiting list for one year. You must fill out a new form at that time to remain on the list. Openings will be filled in order of placement on the list. Please notify us if your address or telephone number changes.

Date:

Has your child previously been on the waiting list? Yes No

Parent / Guardian Name:

Address:

City/State/Zip:

Day Phone Number:

Cell Phone Number [optional]:

Email:

1. Please check the appropriate box below:

Currently attending MCC	Brighton Employee
Faculty / Staff of MCC	Community Member
Plan to attend MCC

2. Interested in child care for:

Fall Semester	Entire Summer
Summer Session 1	Spring Semester
Summer Session 2

3. Schedule request for Spring and Fall Semester:

Monday to Friday – all day	Summer Only Schedule
Monday / Wednesday / Friday – all day	Different schedules available See Office in Person.
Tuesday / Thursday – all day