Waiting List Registration

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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:
Day Phone Number: Cell Phone Number [optional]:
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  
4. Expected graduation date (Student at MCC):
5. Are you or your spouse serving in the U.S, Military (active duty, reserve or guard) or are you a Veteran of the Uniformed Services?
Yes No
6. Payment method:
DSS Cash / Check Credit Card Other
7. Child information:
1. Name Birthday Age
2. Name Birthday Age
3. Name Birthday Age