(FEC) Waitlist Application

(FEC) Waitlist Application
The FEC is a year‐round program, serving children from 3 months to five years. This application does not guarantee enrollment in the FEC. The family is responsible for notifying the FEC of any contact changes, qualifying status changes and schedule changes.

1. Child Information
Child Name

First NameLast Name
Child Birth Date

MonthDayYear
Date
Child Name 2

First NameLast Name
Child Birth Date 2

MonthDayYear
Date

2. Mother / Guardian Information
Mother / Guardian

First NameLast Name
Address - Mother / Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email - Mother / Guardian
example@example.com
Cell Phone - Mother / Guardian
Please enter a valid phone number.
Work Phone - Mother / Guardian
Please enter a valid phone number.

3. Father / Guardian Information
Father / Guardian

Last Name
Address - Father / Guardian

Same as aboveDifferent then above
Address - Father / Guardian Details

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email - Father / Guardian
example@example.com
Phone Number - Father / Guardian
Please enter a valid phone number.
Phone Number - Father / Guardian
Please enter a valid phone number.
Child lives with

MotherFatherBothOther

5. Questions / Comments / Submit Form
Enter your questions or comments here.
Should be Empty: