Tender Years Child Care
Waitlist Request Form
Thank you for your interest in Tender Years Child Care! We understand that finding quality child care for your child is an important decision. Please complete the form below to request placement on our waitlist. Please note: Completing this waitlist form does not guarantee enrollment or a specific start date. Families will be contacted as openings become available based on the child's age, requested schedule, availability, and enrollment needs.
1. Parent/Guardian Information
Parent/Guardian 1 — Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Primary Phone Number
*
Format: (000) 000-0000.
Preferred Method of Contact
Phone Call
Text Message
Email
Parent/Guardian 2 — Full Name
First Name
Last Name
Parent/Guardian 2— Phone Number
Format: (000) 000-0000.
Parent/Guardian 2 — Email Address
example@example.com
2. Child Information
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is your child currently born?
Yes
Back
Next
• No — Expecting
No — Expecting
If expecting, what is the baby's due date?
Optional
Child's Gender
Female
Male
Prefer not to say
Does your child have any siblings who may also need care?
Yes
No
If yes, please provide sibling name(s), age(s), and care needs.
3. Care Requested
Desired Start Date
*
How many days per week are you seeking care?
1 day
2 days
3 days
4 days
5 days
Not sure yet
Requested Care Schedule
Full-Time
Part-Time
Drop-In/Occasional, if available
Estimated Hours Needed Per Week
Less than 20 hours
20-30 hours
31-40 hours
41-50 hours
More than 50 hours
Not sure yet
Back
Next
Preferred Days of Care
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Drop-Off Time
Preferred Pick-Up Time
Is your schedule flexible?
Yes
No
Somewhat
4. Child's Care Information
Has your child previously attended child care?
Yes
No
If yes, please briefly tell us about the previous child care arrangement.
Does your child have any known allergies or dietary restrictions?
Yes
No
If yes, please explain.
Are there any medical, developmental, behavioral, feeding, or other care needs we should be aware of? Please provide information that would help us determine whether we can safely meet your child's needs.
5. Enrollment Information
How did you hear about Tender Years Child Care?
Google
Yelp
Facebook
Instagram
Referral from a current/former family
Friend or family member
Website
Other
Have you toured Tender Years Child Care?
Yes
No
Back
Next
Are you interested in scheduling a tour and receiving information about enrollment when a space becomes available?
Tour
Information
If a space becomes available, how quickly would you be prepared to enroll?
Immediately
Within 1–2 weeks
Within 30 days
More than 30 days
Not sure
6. Additional Information
Please provide any additional information you would like us to know about your child or your child care needs.
7. Parent/Guardian Acknowledgment
By submitting this form, I understand that:
• Completing the waitlist form does not guarantee enrollment or placement.
• Placement on the waitlist does not guarantee a specific start date, schedule, or available space.
• Tender Years Child Care will contact me when an appropriate opening becomes available.
• I am responsible for providing accurate and current contact information.
• I understand that enrollment is subject to availability and completion of all required enrollment documents.
• I understand that additional enrollment requirements, fees, and policies may apply when a space becomes available.
Parent/Guardian Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Electronic Signature
Type your full name to acknowledge the information above.
Preview PDF
Submit
Should be Empty: