Cornerstone Waiting List
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Parent Name *
Phone Number *
Email *
Preferred contact method: *
Required
Desired Start Date *
MM
/
DD
/
YYYY
Payment Method *
 Child 1 Name *
Child 1 Birthday *
MM
/
DD
/
YYYY
Child 2 Name
Child 2 Birthday
MM
/
DD
/
YYYY
Child 3 Name
Child 3 Birthday
MM
/
DD
/
YYYY
If your child is a school ager, what school do they attend?
Comments/questions
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