Wait List Application

Wait List Application
This application does not guarantee enrollment, enrollment by the desired start date, or the desired schedule requested. We will contact you when a space becomes available.

**There is a one-time non-refundable $80.00 registration fee due per family to hold your space. This fee is not due with the wait list application, only when a space has been offered by the Co-op to your family.
Date*

MonthDayYear
Date
Desired Start Date*

MonthDayYear
Date
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Parent Name 1*

First NameLast Name
Parent Name 2

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about the Co-op?
UO Affiliation
How are you affiliated with UO?*

StudentFaculty/StaffN/A
Check any that apply:

I will be a Spencer View residentCommunity family (not affiliated with the University of Oregon)
UO Student
Full time or part time student? (Required if student)
Full Time or Part Time
Anticipated Graduation Date (Required if student)
Check one below: (Required if student)

UndergraduateLawGraduateAEI
What is your major? (Required if student)
UO Faculty/Staff
UO Employee? (Required if faculty/staff)

FacultyStaff
If UO Employee, which department? (Required if faculty/staff)
Desired Scheduling
Which age group?*

InfantWobblerToddlerPre-SchoolPre-K/KindergartenSchool Age
Desired Schedule

Full TimeMon/Wed/FriTues/Thurs
For Kindergarten
Which public school does your child attend?
16.5 hrs/wk kindergarten afternoon care

Monday - Friday
Or check which days apply:

MondayTuesdayWednesdayThursdayFriday
For School Age
Which public school does your child attend?
16.5 hrs/wk school age afternoon care

Monday - Friday
Or check which days apply:

MondayTuesdayWednesdayThursdayFriday
Should be Empty:

Wait List Application

UO Affiliation

UO Student

UO Faculty/Staff

Desired Scheduling

For Kindergarten

For School Age