Waiting List Registration Form

Baby Bear Family Daycare Wait List Registration Form
Please complete this form only if you have been informed that there are no current openings and would like to wait for a spot. All registrations are received and reviewed on a first come, first serve basis. Completing this Registration Form does not guarantee placement. When you are notified of the next available opening, you will have 5 days to complete an enrollment contract and submit a non-refundable enrollment fee. Failure to do so will forfeit your spot and it will be offered to the next family on the list.
Expected Start Date *

Month Day Year
Expected Departure Date (if any)

Month Day Year
Drop Off Time *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
What days of the week are you looking for care? *

Tuesday Wednesday Thursday Friday
How long are you willing to wait for a spot to become available? *
Child Information
First Name *
Last Name *
Birth Date *

Month Day Year
Date
Home Phone *
Gender *

Female Male
Address *

Street Address

Street Address Line 2

City State

Zip Code
Parent Information
Parent/Guardian 1 *

First Name Last Name
Cell *
Work *
E-mail *
example@example.com
Parent/Guardian 1 (if address is different than child's)

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian 2 *

First Name Last Name
Cell *
Work *
E-mail *
example@example.com
Parent/Guardian 2 (if address is different than child's)

Street Address

Street Address Line 2

City State

Zip Code
Other Information
Is your child immunized? *

Yes No
Does your child have any allergies? *

Yes No
Has your child been in daycare before? *

Yes No
If yes please list, including any food or drug allergies.
Does your child have any medical conditions? *
Does your child require any medication? If yes, please list these medications. *
Were you referred by anyone? *
Comments
Please contact us if you have any questions about the Wait List Registration.

Email: info@babybeardaycare.org

Phone: 978-703-3853
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Baby Bear Family Daycare Wait List Registration Form

Child Information

Parent Information

Other Information