Community Waitlist Application

Please note that there is a $25 fee associated with this form. Your child will be put on the waitlist when the fee is received.

Child's Name (First and Last)
Date of Birth Date of Birth / MM / DD YYYY
Please describe any affiliation you have with Bard College
Parent/Guardian Contact Information

This is the primary contact for this child. There is space below to add a secondary contact.
Name (First and Last)
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Preferred Method of Contact

Preferred Method of Contact Home Phone Cell Phone Email
Parent/Guardian Secondary Contact
Name (First and Last) Name (First and Last) First Last
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Preferred Method of Contact

Preferred Method of Contact Home Phone Cell Phone Email
Program Selection
How many days per week would you like your child to attend?

How many days per week would you like your child to attend? 5 Days per Week 4 Days per Week 3 Days per Week
Will your child need afternoon child care?

Will your child need afternoon child care? Yes No
If yes, what time do you plan on picking them up?

If yes, what time do you plan on picking them up? 12:45 pm - After lunch 4:00 pm - After Nap 4:00–5:15 pm - Extended day