Wilshire ECLC Waitlist Form

Submission

MonthDayYear

Little Dreamers

Website: www.littledreamers24.com

We don't have a projected opening. We are working on funding for custom build outs. We will notify progress via Facebook bimonthly updates for the upcoming year.

Check which best describes your need for childcare.

I cannot work until I find childcareI am planning on being a future Employee at Little DreamersMy work shift is marginalized in the childcare industryNone of these apply to me

Which center would you like to include your child or children to be on its waitlist?

LaunchPad CenterStar Solutions Center

Expected Birth Date

MonthDayYear

(First Child) Gender

First Child's Name

First NameLast Name

(First Child) Birth Date

MonthDayYear

(First Child) Gender

Second Child's Name

First NameLast Name

(Second Child) Birth Date

MonthDayYear

(Second Child) Gender

Third Child's Name

First NameLast Name

(Third Child) Birth Date

MonthDayYear

(Third Child) Gender

(Fourth) Child's Name

First NameLast Name

(Fourth Child) Birth Date

MonthDayYear

(Fourth Child) Gender

How to Complete this Section:

The purpose of this section is to see when children will likely be at the center and use this as a guide to create reasonable Drop Off/Pick Up policies. This form is meant to accommodate as many schedules as possible, but it may not work for everyone.
You can use whatever method works best for you; some may choose to estimate to the nearest hour around their work schedules, some may use a 10-hr period (5am-3pm), some may want to use exact times.

If you work the same schedule every week, you only need to fill out the week 1.

Example 1: You work 6am to 2pm. Travel time to Crossroads Commons (Stevens Point) is 15 min from Home and 25 min from Work. So you estimate a 30 min buffer for Drop Off and 45 min for Pick Up.

Drop Off/Arrival Time 5:30am

Pick Up/ Departure Time 2:45pm

If you don’t know the exact times of your weekly schedule, that is okay. Use the blank sections in this chart to indicate Time Periods such as: early morning, late morning, mid-day, afternoon, late afternoon, evening, or late night.

Example 2: Your schedule fluctuates weekly. Your travel time to Crossroads Commons (Stevens Point) is 30 min. You estimate a 60 min buffer, however, since you don't know your exact times, you indicate time periods. You could also use phrases like First Shift, Second Shift, or Third Shift.

Drop Off/Arrival Time Early Morning

Pick Up/ Departure Time Late Afternoon

Typically, you would know which times you don't work. For Example: You know you work no earlier than 5am and no later than 7pm. You could use an Drop Off Time: Early Morning and a Pick Up Time: Late Evening

For some of you, your schedules will be more complex than this chart. Just use your best judgment or use the schedule from previous months you’ve worked. If you feel you can’t provide exact times of your schedule, explain in the Comments section. If you don't indicate which shift you work (First, Second, or Third) or give time periods this may affect where you are ranked in being waitlisted.

If you have a Partner who works a different schedule than you, you could use weeks 1+2 for your schedule and weeks 3+4 for theirs. Or use the Comments section to explain.

I currently don’t have employment so therefore I do not know my schedule or needs*

This applies to meThis doesn’t apply to me. (Fill out next section)

WEEK 1 *

	Mondays	Tuesdays	Wednesdays	Thursdays	Fridays	Saturdays	Sundays
Drop Off/ Arrival Time
Pick Up/ Departure Time

WEEK 2 (if different from week 1)

	Mondays	Tuesdays	Wednesdays	Thursdays	Fridays	Saturdays	Sundays
Drop Off/ Arrival Time
Pick Up/ Departure Time

WEEK 3

	Mondays	Tuesdays	Wednesdays	Thursdays	Fridays	Saturdays	Sundays
Drop Off/ Arrival Time
Pick Up/ Departure Time

WEEK 4

	Mondays	Tuesdays	Wednesdays	Thursdays	Fridays	Saturdays	Sundays
Drop Off/ Arrival Time
Pick Up/ Departure Time

HOLIDAYS This section is for those that work on paid holidays. You may not know your exact times or which holidays you work. That is okay. You could use last year work schedule as reference. Or you can make a guess of what you would work. It would be most helpful if you could say specific time periods (such as: early morning, late morning, mid-day, afternoon, late afternoon, evening, or late night) that you would likely work instead of leaving sections blank. If you will be in a new position once you have childcare, you can just indicate in the Comments that this is a new job, therefore you don’t know your schedule.

	Labor Day	Thanksgiving Day	Friday after Thanksgiving (Black Friday)	Christmas Eve	Christmas Day	New Year’s Eve	New Year’s Day	Easter	Memorial Day	Juneteenth & Juneteenth Observance Day	Independence Day (4th of July)
Drop Off/ Arrival Time
Pick Up/ Departure Time

Do you work any of these additional paid holidays? Not every Employer considers these as paid holidays. Only select if your employer considers these as a paid holiday that you potentially could work.

Additional Comments on Schedules from above. This is a great opportunity for those who may not know their exact times of their work schedules but can indicate time periods such as: early morning, morning, late morning, mid-day, afternoon, late afternoon, evening, or late night. Also indicate the days. Example: “My schedule fluctuates weekly. I usually work Mondays, Wednesdays, and Fridays. I usually will drop off in the late mornings and pickup in the evenings. I sometimes work Tuesdays and Saturdays, usually able to drop off in early mornings and pickup in the late afternoons.” You can also explain why you may not know your schedule/time when Care is needed. You can also explain your holiday schedule here.

Parent or Guardian’s Name*

Phone Number

Area CodePhone Number

Email*

(Partner’s) Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Who is filling out this form?

Parent or Guardian in a Single Parent HouseholdParent representing a Two Parent HouseholdParent or Guardian representing Shared Custody (only one form is needed)Someone who is representing a family whose English isn’t their first languageSomeone who is representing a parent who is a Minor

Signature*

Did you attend any of Marion Schneider’s Childcare Marketing events (Free Holiday & Drop In Care) during Fall 2021? OR did you attend one of the early fundraisers for Little Dreamers Academy? You’ll be eligible for a future discount. This section will be verified. Check all that apply.

Holiday Care: Black Friday ShoppingHoliday Care: Shop Small Business Saturday/Christmas ShoppingHoliday Care: Christmas DayHoliday Care: New Year’s Eve Bash/SleepoverHoliday Care: Valentine’s Day Date Night DuoSt Patrick’s Day Date Night FundraiserDino Dig/Dino Dig 2 Fundraiser

Check any that apply. Any of these are also eligible for a future discount. This section will be verified.

Joined Little Dreamers Academy Waitlist Facebook GroupJoined Point Area 24HR Care: Little Dreamers Academy Facebook GroupDonated item(s) to this daycareVolunteered at any of the free childcare events/fundraisersJoined Dream Team Facebook group

Are you interested in any of these additional offerings?

Feeding my child Supper (5pm-6pm) before PickUpBath (infants-schoolers)Accommodations for no technology (traditional paperwork)Infant Sleep Training ConsultingBaby/Toddler Sign Language ClassPlay Date Small GroupsFirst Time Parent Social GroupSunday Brunch with Moms (discuss current American expectations + experiences in Motherhood)Dads Club

Additional comments regarding schedule and/or contact info

Pre-Opening Waiting List & Pre-Enrollment

Needs Assessment

Program Selection

New Parent Section

Children’s Pre-Enrollment Information

Days & Times Care is Needed

Parent Contact Info

Additional Feedback Survey