Waiting List Registration

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NOTICE: Your child will be placed on the waiting list. Openings will be filled in order of placement on the list. Please notify us if your needs or contact information changes.

Date: Has your child previously been on the waiting list?
Parent / Guardian:

First Name:   Middle Initial:   Last Name:
Address 1:

Address 2:

City:   State:   Zip:
Day Phone Number: Cell Phone Number: (Optional)
Email: M Number:
1. Please check the appropriate box below:

2. Interested in child care for:

For the following year:
3. Schedule request for Spring and Fall Semester:

Preferred start date:
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?
6. Payment method:
7. Child information:
1. Name Birthday
2. Name Birthday
3. Name Birthday