Whitefoord Early Learning Wait List Form

Thank you for your interest in enrolling your child in Whitefoord's Early Learning Program! Please note: Submission of the Wait List Form does not guarantee admission for your child. Applications are accepted year round. If you have not done so, please review our Wait List Policy and FAQs at: www.whitefoord.org/s/Whitefoord-Wait-List-Policy.

Additionally, a $25.00 non-refundable fee must accompany this form. Forms will not be considered until fee has been paid! If you cannot pay online, then please bring a printed copy of the form with check, cash, or money order payment to Whitefoord's office.

Again, thank you for your interest in Whitefoord’s Program!

Contact Information

Parent's Name

Prefix

First Name

Last Name

Suffix

Verify Email

Cell Phone Number

Home Phone Number

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Child's Name

First Name

Last Name

Child's Date of Birth

(mm/dd/yyyy)

Child's Age

Child's Gender

Male

Female

Enrollment Category

Full Pay

Quality Rated Voucher

Tuition Assistance

Requested Start Date

(mm/dd/yyyy)

Are you pregnant?

Are you pregnant with the child you wish to enroll?

Yes

Due Date

(mm/dd/yyyy)

Are you currently employed?

Yes

Average Annual Household Income

Please enter only numbers.

Do you have or are you eligible for state Childcare Assistant Program Services (CAPS)?

Yes

Waitlist Fee