(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.
- Child Name
  
  First NameLast Name
- Child Birth Date
  
  MonthDayYear
  Date
- Child Name 2
  
  First NameLast Name
- Child Birth Date 2
  
  MonthDayYear
  Date
- Parent / Guardian
  
  First NameLast Name
- Address - Parent / Guardian
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email - Parent / Guardian
  example@example.com
- Cell Phone - Parent / Guardian
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone - Parent / Guardian
  Please enter a valid phone number.Format: (000) 000-0000.
- Select one preferred schedule. We will let you know of any availability.
- Parent / Guardian (2)
  
  Last Name
- Address - Parent / Guardian (2)
- Address - Parent / Guardian (2) Details
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email - Parent / Guardian (2)
  example@example.com
- Phone Number - Parent / Guardian (2)
  Please enter a valid phone number.Format: (000) 000-0000.
- Phone Number - Parent / Guardian (2)
  Please enter a valid phone number.Format: (000) 000-0000.
- Child lives with
  
  Other
- Please check your qualifying status:
- Preferred Schedule (check only one)
- Alternate Schedule (check one or more)
- Family Size
- Enter your questions or comments here.
- Rank the colors
- Rank the colors
- Should be Empty: