Waitlist Application

The Child Development Center almost always operates at full capacity, but we urge you to fill out our short application to hold a spot on our waiting list.

We will contact you as soon as we can regarding openings in our classrooms to let you know when your child will be able to join our community. Thank you!

Parent first and last name:

Affiliation with the ��Ƶ:

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Faculty

Staff

Please indicate your affiliation with the ��Ƶ of ��Ƶ at Lafayette. Please note: ��Ƶs must be enrolled in at least 9 credit hours to be eligible for childcare.

��Ƶ ID number:

Email address:

Home phone number:

Cell phone number:

Child's first and last name:

Child's birthday:

Child's birthday:: Year

Child's birthday:: Month

Child's birthday:: Day

Please indicate the number of days needed for childcare:

Five days a week

Monday-Wednesday-Friday

Tuesday-Thursday

Are you on childcare assistance or eligible for it?

Yes

Don't know

When would you need childcare services to start?

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Waitlist Application

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