LC Waiting List
Read Waitlist Agreement
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Child First Name
*
Child Last Name
*
Date Submitted
*
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Date to Begin Care
*
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Child's DOB
*
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Calendar
Room (Initial)
*
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Parent/Guardian's Name
*
Relationship to Child
*
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Address
*
Phone Number
*
E-Mail
*
Paid Waitlist Fee
*
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Days Desired
*
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