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DCO Childcare Waiting List
Please complete and submit this form if you are interested in placing your child on the waiting list.
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* Indicates required question
Email
*
Your email
I understand this is NOT HIPPA SECURE communication and I am not obligated to provide any health information or diagnosis.
*
yes
Required
Applying for
*
ASAP
3 Months (Oct. 2022)
6 Months + (July 2023)
Other:
CHILD ONE - First Name / Last Name
*
Your answer
CHILD ONE - Birthdate
MM
/
DD
/
YYYY
CHILD TWO - First Name / Last Name
Your answer
CHILD TWO - Birthdate
MM
/
DD
/
YYYY
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