Madison Area Technical College (MATC) Child and Family Centers Waiting List Form

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Waiting List Form

Child and Family Centers

Parent Information

First Name:

Last Name:

Street Address:

City:

State:

ZIP Code: Example: 55555

Telephone (Home): Example: (000) 000-0000

Telephone (Work):

Telephone (Cell):

Email: Example: email@address.com

Session Desired:

Center Desired:

Days and Hours Needed

Notes:

Center Hours: 7:15 am to 4:30 pm.
Minimums: Child care minimum is 2 days/week and 2-1/2 hours/ day.
Drop Off Times: Drop off by 11am or not until 2 pm due to lunch and nap times.
Billing: We bill on the quarter hour, so please indicate times accordingly.

Monday until

Tuesday until

Wednesday until

Thursday until

Friday until

Child Information

1) Child's Name:

Date of Birth: Example: 00/00/0000

2) Child's Name: