Wait List Form

Thank you for printing and filling out this form completely. date: ______preferred start date*:______*please be as accurate as possible as this date is used to determine enrollment offers BCDC Wait List Form

Child Name: ______DOB or Due Date: ______(Month) (Date) (Year)

Parent /Guardian Information

Name: Relationship: Mother Father Other:

Address: (Number) (Street) (Apt. #)

(City) (State) (Zip Code)

Phone: ( ) ______Business phone: ( ) ______

Cell Phone: ( ) ______Email: ______

Employer: ______

Name: ______Relationship: Mother Father Other:______

Address: (Number) (Street) (Apt. #)

(City) (State) (Zip Code)

Phone: ( ) ______Business phone: ( ) ______

Cell Phone: ( ) ______Email: ______Employer: ______

How did you hear about BCDC? Word of mouth A BCDC Parent Other ______

This completed form should be mailed along with your non-refundable $100 Wait List Fee to: BCDC 3400 International Dr. NW, Washington, DC 20008.

OFFICE USE ONLY Classroom:______Deposit paid:______Date received: ______Check #: ______

Priority: Sibling Building Tenant Community