ECC Waiting List 20-21
Thank you for applying for child care at our center. We will notify you as soon as we have an opening for your child. Please note that a new application must be completed each school year to ensure that your child's name remains on the waiting list. Completion of this form does not guarantee that your child has been enrolled in the Employee Child Care Program.
Email address *
Child's Name (First, Middle and Last) *
Name Child is Called *
Date of Birth *
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Mother's Name *
Mother's Place of Employment *
Mother's Home Phone *
Mother's Work Phone *
Father's Name *
Father's Place of Employment *
Father's Home Phone *
Father's Work Phone *
I am interested in enrolling my child for *
Required
My Preferred Location is: *
First-day child care is needed *
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