Waiting List Application
This waiting list is based on a first come first serve basis. Please fill out the waiting list application and return as soon as possible. MUM'S operates a 1/2 day preschool as well as an afternoon after-school program from the 3 elementary schools in Mebane. During the summer we operate a full day summer camp program for children finishing kindergarten through 5th grade.
Email address *
Child's full name? *
Mother's name? *
Father's name? *
Gender? *
Child's birthdate? *
MM
/
DD
/
YYYY
Phone number: *
Email Address: *
Residing county *
What elementary school does or will your child attend? *
What type of care are you interested in? *
Allergies or daily medications *
Needs that we may help your child with? *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy