Sandhills First Steps Waitlist Application Question Title * 1. Parent/ Guardian Name Question Title * 2. email contact Question Title * 3. phone contact Question Title * 4. Hours needed Date / Time Time AM/PM - AM PM Question Title * 5. Days of the Week needed Mon-Fri Monday Tuesday Wednesday Thursday Friday other Question Title * 6. Subsidy Eligible Yes No Question Title * 7. Special Needs Required Yes No Question Title * 8. Infant: 6wk-15 mo Yes No Question Title * 9. Toddler: 16 mo-35 mo Yes No Question Title * 10. 3yr old Yes No Question Title * 11. 4 yr old Yes No Question Title * 12. After school Care needed Yes No Question Title * 13. How many children after school Done