PreK Moms Waitlist

Please complete the waitlist form below to be considered for the PreK Moms program. We are nearing capacity and someone will reach out to you to let you know if you've been accepted into the program!

First Name

Last Name

Cell Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Birthdate

Husband's Name (if applicable)

Home Church (if applicable)

How did you hear about us?

Please provide the name(s), gender, and birth date(s) for each child who will be in our Childcare program during the PreK Moms meetings.

Please list any allergies or special instructions for child(ren) who will be in our Childcare program.

Name & cell number of individual(s) authorized to pick up child(ren) in case of an emergency.

Scholarship

Please contact me with scholarship info.

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