Child Waitlist Application

Child Waitlist Application
Child's Name*

First NameLast Name
Parent/Guardian *

First NameLast Name
Mobile Phone Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Anticipated Drop Off*

:HourMinutesAM/PM Option
Anticipated Pick Up*

:HourMinutesAM/PM Option
Child's Birth Date/Due Date*

MonthDayYear
Date
Desired Start Date*

MonthDayYear
Date
Fees: A $50.00 non-refundable waitlist fee will be due to secure your spot on the waitlist. This fee will be paid through our Brightwheel mobile application. More information about our Brightwheel app will be sent to the email listed on this form. Once we have received the payment, your spot will be held for one week past the desired start date listed above.
Additional Comments
Should be Empty: