Kids' Corner Waiting List Form
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Information:
Parent 1: Full Name
*
First Name
Last Name
Parent 2: Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Child's Name and Birth Date
Requested Start Date
Currently Pregnant
Yes
No
Projected Due Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Other children requesting care
Weekly Childcare Schedule:
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Arrival
Departure
Hours
Total hours/week (must pay for a minimum of 35 hours/week)
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: