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Children's Center Waiting List
Please fill out a separate form for each child. We will contact you when there is space for your child. If you do not hear from us, there is no space available.
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* Indicates required question
Email
*
Your email
Your Name (Last, First)
*
Your answer
Your child's name (Last, First)
Your answer
Your child's birthdate (or due date)
*
MM
/
DD
/
YYYY
Grade in school, if any
Your answer
Are you (select one)
*
UW-Platteville student
UW-Platteville or Platteville Public Schools Faculty or Staff
Community member (everyone else)
Do you have another child CURRENTLY attending the Children's Center (any location)?
*
Yes
No
Phone Number
*
Your answer
email address
*
Your answer
Notes (request specific days, give a second email address, etc.)
Your answer
A copy of your responses will be emailed to the address you provided.
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