Request for School Age Waiting List Placement

Name

First

Last

Layout

Email Address

Home Phone Number

Cell Phone Number

Home Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Layout

Child Name 1

Child Birthdate 1

Child Name 2

Child Birthdate 2

Child Name 3

Child Birthdate 3

Kindergarten

Before School
After School
P. A. Days - Holidays
Summer Care

Grade one and older

Before School
After School
P. A. Days - Holidays
Summer Camp

Layout

Child Arrival Time

Departure Time

Parent's Name 1

Parent's Work Phone Number 1

Parent's Name 2

Parent's Work Phone Number 2

Method of Payment

Fee Paying
Subsidized: Full
Partial

Comments/ Questions

Start Date

Note: The waiting list will be maintained in a manner that protects the privacy and confidentiality of the children and families on the list and therefore only the child’s position on the waiting list will be provided to parents. Names of other children or families and/or their placement on the waiting list will not be shared with other individuals.

Child Care Registration

School Age Waiting List Form Submission

Request for School Age Waiting List Placement