RHK Waiting List
Please take a minute to fill this questionnaire out for each child you’d like to place on our waiting list.
Typically we require a site visit prior to being placed on our waiting, however due to COVID-19 a visit will not be required at this time.
* Required
Email address
*
Your email
Today’s date
*
MM
/
DD
/
YYYY
Your name
*
Your answer
Your child’s name
*
Your answer
Your child’s age
*
Your answer
Your child’s date of birth
*
MM
/
DD
/
YYYY
Home phone
Your answer
Cell phone
*
Your answer
Preferred contact choice
*
Call me at home
Call me on my cell phone
Text me
E-mail me
Other:
Required
Requested childcare start date
*
MM
/
DD
/
YYYY
What days will childcare be needed?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
How did you hear about us?
Your answer
Do you have any other questions for us?
Your answer
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