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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.

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




     
(Optional)
1. Please check the appropriate box below:




2. Interested in child care for:







3. Schedule request for Spring and Fall Semester:








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: