Child Care Waitlist Form

Person Filling in Form*

First Last

Relation to Child(ren)*

Phone

Email*

First Child's Name

First Last

Second Child's Name (if applicable)

First Last

Third Child's Name (if applicable)

First Last

School your child(ren) attends?

How many children would you like to register for the Before School Child Care Program*

Day(s) of the week that you need the Before School Child Care Program (choose all that apply)*

How many children would you like to register for the After School Child Care Program*

Day(s) of the week that you need the After School Child Care Program (choose all that apply)*

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