Waiting List Application | First Steps PEC

Name of Child
First Last
Date of Birth
Age Group
- infant-toddler
- preschool-kindergarten
Siblings currently attending and / or have attended First Steps
Parent / Guardian Information
First Last
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone Number
Alternative Phone Number
Email
*
- I understand that this is NOT a registration form, and that it doesn't guarantee a place at First Steps
Electronic Signature*
Date*
Date Format: MM slash DD slash YYYY