Waitlist Program Form
Child Information
Select the program of interest:
Infant/Wobbler/Toddler
Two's
La Escuelita Preschool
WeParent + Me
Big Kids
Summer Camp 2023
Select Your Schedule
*
Full-Time
2-Days (T/TH)
3-Days (M/W/F)
Name of Child (First, Middle Initial, Last):
*
First Name
Middle Name
Last Name
Name of Child (First, Middle Initial, Last):
*
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Parent's Information
Guardian(s) of the child(ren)
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Waitlist Fee- https://venmo.com/u/WeVillage
Please pay your non-refundable waitlist fee for the program you have selected.
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I consent to WeVillage charging me in the total amount of $75 non-refundable waitlist fee. I understand that my spot in the selected program is not guaranteed.
Submit
Should be Empty: