Bright and Early Learning and Child Care Center
Waitlist Application
Email *
Child's Name *
Birth Date or Due Date *
MM
/
DD
/
YYYY
Address and Zip code *
What school district do you reside in? *
Parent/Guardian's Information
First Parent/Guardian
Name *
Complete Home Address *
Home or Cell Number *
Work Number *
Second Parent/Guardian
 *
Complete Home Address *
Home or Cell Number *
Work Number *
How did you hear about our Center
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Your Needs
When do you expect to need care *
Will part time or full time care be needed? *
If part time, are you flexible on the days used? *
Has your child been in care before and if so where? *
Are there any special circumstances we should be aware of? *
Submit
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