Wait List Registration Form

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Please complete this form if there are no current openings and would like to wait for a childcare spot. All registrations are received and reviewed on a first come, first serve basis. Completing this Registration Form does not guarantee placement.

When you are notified of an avilable spot, you will be required to complete the enrollment process within 5 days. Failure to do so will forfeit your spot and it will be offered to the next family on the list.

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Expected Start Date* This field is required.

Date

3

Expected Departure Date (if any)

Date

4

Drop Off Time* This field is required.

Hour

Minutes

Until

Hour

Minutes

5

What days of the week are you looking for care?* This field is required.THE DAYCARE IS CLOSED ON MONDAYS

Tuesday

Wednesday

Thursday

Friday

6

How long are you willing to wait for a spot to become available?* This field is required.

7

Are you a teacher?

YESNO

8

Child's Name

First Name

Last Name

9

Birth Date* This field is required.

Date

10

Home Phone* This field is required.

11

Gender* This field is required.

Female

Male

12

Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

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Parent/Guardian 1* This field is required.

First Name

Last Name

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Cell Phone* This field is required.

15

Work Phone* This field is required.

16

E-mail* This field is required.

example@example.com

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Parent/Guardian 1 (if address is different than child's)

Street Address

Street Address Line 2

City

State

Zip Code

Country

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Parent/Guardian 2* This field is required.

First Name

Last Name

19

Cell Phone* This field is required.

20

Work Phone* This field is required.

21

E-mail* This field is required.

example@example.com

22

Parent/Guardian 2 (if address is different than child's)

Street Address

Street Address Line 2

City

State

Zip Code

Country

23

Is your child immunized?* This field is required.

Yes

No

24

Does your child have any allergies?* This field is required.

Yes

No

25

If yes please list, including any food or drug allergies.

26

Has your child been in daycare before?* This field is required.

Yes

No

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Does your child have any medical conditions?* This field is required.

28

Does your child require any medication? If yes, please list these medications.* This field is required.

29

Were you referred by anyone?* This field is required.

30

Comments

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Please contact us if you have any questions about the Wait List Registration.

Email: info@babybeardaycare.org

Phone: 978-703-3853

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