2018-2019 Country Lane Extended Day Wait List Form
Currently, the extended day site at Country Lane is full. Please complete the form to be put on the waiting list for the 2018-2019 school year. A form must be completed for each child. You will be contacted by the site director once a space is available. Please note your position on the 2018-2019 waiting list does not transfer to the following year.
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Parent/Guardian's Contact Number *
Your answer
Parent/Guardian's Email *
Your answer
Child's First Name *
Your answer
Child's Last Name *
Your answer
What grade will your child be in the 2018-2019 school year? *
My child will need care before school? *
Please indicate which days your child needs care before school. (A minimum of 2 days must be selected.) *
Required
My child will need care after school? *
Please indicate which days your child needs care after school. (A minimum of 2 days must be selected.) *
Required
Additional Comments
Your answer
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