Childcare Interest/Waitlist
This form does not guarantee a spot. It does create a priority contact list the Director will utilize for child enrollment. The Director will contact you to set up a tour, view the family handbook, and tuition policy. We are now licensed, and anticipate opening our classrooms between May 18th and June 1st. Email director@thewillowcenternh.com with any questions.
Full name of 1st child
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Full name of 2nd child (if applicable)
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Full name of 3rd child (if applicable)
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Parent/Guardian Name
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How soon are you looking for care to start?
-
Month
-
Day
Year
Date
What kind of care are you looking for?
Childcare
Summer Camp (School Age - Weekly Sessions)
Summer Camp Session(s) participant is interested in? (Weeks 1-10)
Preferred Childcare Schedule (minimum of 2 Days) 7:00am-5:00pm *Summer camp enrollment is based on full weeks, not individual days*
Monday
Tuesday
Wednesday
Thursday
Friday
Any initial questions?
Type a question
Please Select
1
2
3
Signature of parent
Submit
Submit
Should be Empty: