YMCA EARLY LEARNING CENTER
WAIT LIST APPLICATION
Parent/Guardian Information
Name of Parent/Guardian (1)
*
Parent/Guardian (1) Date of Birth:
*
-
Month
-
Day
Year
Date
Contact phone # Parent/Guardian (1)
*
Format: (000) 000-0000.
Email Address Parent/Guardian (1):
*
example@example.com
Name of Parent/Guardian (2)
Parent/Guardian (2) Date of Birth:
-
Month
-
Day
Year
Date
Contact phone # Parent/Guardian (2)
Format: (000) 000-0000.
Email Address Parent/Guardian (2):
example@example.com
Is either parent or guardian an employee of MultiCare Health System?
*
Yes
No
if yes please specify MHS location and department:
Is either parent or guardian an employee of the YMCA?
*
Yes
No
if yes please specify YMCA location and department:
Child Information
Child's Name:
*
Date of birth (or expectant)
*
-
Month
-
Day
Year
Date
2nd Child's Name:
Date of birth (or expectant)
-
Month
-
Day
Year
Date
3rd Child's Name:
Date of birth (or expectant)
-
Month
-
Day
Year
Date
Special Needs or Other info:
Schedule/Payment
Interested Start Date:
*
-
Month
-
Day
Year
Date
Times Requesting Care:
*
Days Requesting Care:
*
Monday
Tuesday
Wednesday
Thursday
Friday
How will fees be processed? (Please mark one)
*
Private Party
Third party Agency:
Third Party Agency Type
New Adventures is a private pay facility and are only set up to accept certain third party subsidies.
What ELC location would you be interested in having your child enrolled in? (select all that apply)
*
YMCA Puyallup ELC (ages 2 1/2-5 and potty trained)
YMCA University Place ELC (infants to 5 year olds)
YMCA New Adventures ELC (infants to 5 year olds)
Other (please list any further comments)
- MultiCare employed families will receive priority on the list for New Adventures ELC
-There are NO guarantees for care by returning this form. Offers are made based on classroom availability.
-It is the responsibility of the applicant to contact the center for status, updates, or changes of wait list applications.
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