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Full Day and Half Day Preschool Waiting List Application

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Steps

1. Interest Information This section is complete This section is incomplete
2. Children Information This section is complete This section is incomplete
3. Parent Contact Information This section is complete This section is incomplete
4. Program Specific Information This section is complete This section is incomplete

Interest Information

Which Waiting List?*
1. Full Day Preschhol
1. Half Day Preschool
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Children Information

Child Name*
Gender*
Date of Birth*
Child Name
Gender
Date of Birth
Child Name
Gender
Date of Birth
Child Name
Gender
Date of Birth
Child Name
Gender
Date of Birth
Has your child had a free developmental screening with CDS-CC?*
Do you have any concerns about your child's development?*
Please include details about any/all areas of concern.
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Parent Contact Information

Parent First Name*
Parent Last Name*
Parent First Name
Parent Last Name
Address1*
Address2
City*
State*
Zip*
Contact Phone Number*
Secondary Phone Number
Email
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Program Specific Information

How many days would you prefer?*
1. 2 half day
1. 4 half day
1. Either
What is your session preference?*
1. Mornings
2. Afternoons
3. Either
Employer
Work Phone
Employer
Work Phone
Days Worked
1. Monday
2. Tuesday
3. Wednesday
4. Thursday
5. Friday
Times Worked
Times Worked Start Time
—
Times Worked End Time
Days Worked
1. Monday
2. Tuesday
3. Wednesday
4. Thursday
5. Friday
Times Worked
Times Worked Start Time
—
Times Worked End Time
Household Gross Income*
Number in Household*

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Campbell County
500 S. Gillette Ave.
Gillette, WY 82716
Campbell County:
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