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Waiting List Application Form
Thank you for your interest in the Dare to Dream Child Development Center. Please complete the form below and we will be in touch about available space for your child.
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Date toured the center
MM
/
DD
/
YYYY
Pre-enrollment visit date
MM
/
DD
/
YYYY
Child's name
Your answer
Child's birthdate
MM
/
DD
/
YYYY
Name child likes to be called
Your answer
Parents/Custodial Parents
Mother's name
Your answer
Mother's work phone
Your answer
Mother's work hours
Your answer
Mother's cell phone
Your answer
Mother's home phone
Your answer
Mother's home address
Your answer
Mother's email address
Your answer
Father's name
Your answer
Father's work phone
Your answer
Father's work hours
Your answer
Father's cell
Your answer
Father's home phone
Your answer
Father's address
Your answer
Father's email address
Your answer
Childcare questions
Date care is needed
MM
/
DD
/
YYYY
Is child potty trained
Yes
No
Clear selection
Special medical needs
Your answer
Has your child been in a child care setting before?
Yes
No
Clear selection
How did you hear about Dare to Dream?
Your answer
Why did you choose this center?
Your answer
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