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Mom's Day Out Wait List 2019-2020
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* Indicates required question
Child's Name
*
Your answer
Birthdate
*
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Child's Name (2)
Your answer
Birthdate
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Which day would you like to register for?
*
Tuesdays, 9 am-2 pm -- $90 per month
Wednesdays, 9 am-2 pm -- $90 per month
Thursday Mornings 9:30 am - 1 pm -- $65 per month
Required
Mom's Name
*
Your answer
Phone number
*
Your answer
Email
*
Your answer
Dad's Name
*
Your answer
Phone number
*
Your answer
Email
Your answer
Person(s) who will be dropping off and picking up. Please list name and phone number.
*
Your answer
Is your child potty trained?
*
Yes
No
In the process of potty training
How did you hear about Mom's Day Out?
Facebook ad
Facebook yardsale page
Library
Returning student
Other:
Clear selection
If you were referred by a friend, who referred you?
Your answer
Do you give permission for your child's image to appear on the Mom's Day Out Facebook page and Mom's Day Out website? Give your permission by typing your name below. If you do not give your permission, please leave blank.
Your answer
Monthly Tuition
Tuition rates are as follows:
$90 per month for one child 9 am - 2 pm.
$170 per month for two children (siblings).
Thursday Mom's Morning Out: $65 for one child 9:30 am - 1 pm.
Thanks so much for submitting your wait list form! I'll be in contact with you ASAP to let you know about any upcoming openings.
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