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.Format: (000) 000-0000.
How did you hear about the Co-op?
UO Affiliation
How are you affiliated with UO?
Check any that apply:
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)
What is your major? (Required if student)
UO Faculty/Staff
UO Employee? (Required if faculty/staff)
If UO Employee, which department? (Required if faculty/staff)
Desired Scheduling
Which age group?
Desired Schedule
For Kindergarten
Which public school does your child attend?
16.5 hrs/wk kindergarten afternoon care
Or check which days apply:
For School Age
Which public school does your child attend?
16.5 hrs/wk school age afternoon care
Or check which days apply:
Should be Empty:

Wait List Application

UO Affiliation

UO Student

UO Faculty/Staff

Desired Scheduling

For Kindergarten

For School Age