YMCA EARLY LEARNING CENTER
WAIT LIST APPLICATION
Parent/Guardian Information
Name of Parent/Guardian (1)
*
Parent/Guardian (1) Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit 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
2 digit month, 2 digit day, 4 digit 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
2 digit month, 2 digit day, 4 digit year
Date
2nd Child's Name:
Date of birth (or expectant)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
3rd Child's Name:
Date of birth (or expectant)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Special Needs or Other info:
Schedule/Payment
Interested Start Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Times Requesting Care:
*
Days Requesting Care (select all that apply):
*
Monday
Tuesday
Wednesday
Thursday
Friday
How will fees be processed? (Please mark one)
*
Self Pay
DCYF-State Subsidy
Military-Child Care Aware/MCCYN
New Adventures is not set up to accept DCYF-state subsidy.
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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