Second Presbyterian Child Care Center- Wait List Registration Form
Please complete the form below to join the 2PCCC Wait List. Print off the form and mail it, along with a check for the wait list fee, to: Second Presbyterian Child Care Center, 5 N. Fifth Street, Richmond, VA, 23219. The current fee is $40.
Child's Name *
Your answer
Date of Birth/ Expected Date of Birth *
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DD
/
YYYY
Date Enrollment is needed *
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DD
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YYYY
Does the child have siblings currently enrolled at 2PCCC? *
Are you currently a member of 2nd Presbyterian Church
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone
Your answer
Parent's Name *
Your answer
Parent's Cell *
Your answer
Parent's Work Phone
Your answer
Parent's Email *
Your answer
Parent's Name
Your answer
Parent's Cell
Your answer
Parent's Email
Your answer
How did you hear about us?
Your answer
Please initial here to be added to the waitlist *
Your answer
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