WAITLIST FORM CHILD'S INFORMATION 1) Child's Name: 2) Child's Age, BIrthdate, or Due Date: 3) Child's Home Address: 4) Do you have another Child (or Children) at our center? No Yes If yes to #4, please provide Name(s) and Ages: CHILDCARE INFORMATION 5) Desired Start Date? 6) Please indicate what session? Full-time (Monday - Friday) Part-time (Monday - Friday) PARENT / GUARDIAN # 1 INFORMATION 7) Parent / Guardian # 1 Name and Relationship to Child: 8) Parent / Guardian # 1 Cell Phone: 9) Parent / Guardian # 1 Home Phone: 10) Parent / Guardian # 1 Email Address: PARENT / GUARDIAN # 2 INFORMATION 11) Parent / Guardian # 2 Name and Relationship to Child: 12) Parent / Guardian # 2 Cell Phone: 13) Parent / Guardian # 2 Home Phone: 14) Parent / Guardian # 2 Email Address: TELL US ABOUT YOU? 15) How did you hear about Rising Stars Daycare? 16) If someone referred you, please provide their name: 17) What other daycare centers or childcare arrangements are you considering? 18) Is there anything else you would like to share? Send
