Wait List Registration Form

Please complete this form if there are no current openings or you would like to wait for a future childcare spot. All registrations are received and reviewed on a first come, first serve basis and will be placed according to age-group availability. Completing this form does not guarantee placement. When you are notified of an available spot, you will be required to complete the enrollment process within 5 days. Failure to do so will forfeit your spot and it will be offered to the next family on the list.
Child Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

FemaleMale
Is your child immunized?*

YesNo
Has your child been in daycare before?*

YesNo
Does your child have any allergies?*

YesNo
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.*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent Information
Parent/Guardian 1*

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

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian 2*

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

Street Address

Street Address Line 2

CityState

Zip Code
Were you referred by anyone?*
Comments
Childcare Preferences
Expected Departure Date (if any)

MonthDayYear
Expected Start Date*

MonthDayYear
How long are you willing to wait for a spot to become available?*
What days of the week are you looking for care?*

TuesdayWednesdayThursdayFriday
Hours of Care*

Start Time

AM/PM Option

Until
until
Pick Up Time

AM/PM Option
Please contact us if you have any questions about the Waitlist Registration.

Email: info@babybeardaycare.org

Phone: 978-703-3853
Should be Empty:

Child Information

Parent Information

Childcare Preferences