Student Wait List Application

Please complete the follow application to have your child placed on our waiting list. Please Note: All questions must be answered. If it does not apply to you or your child, select or input 'N/A' - Applications with skipped answers will be discarded.
To be considered for a spot, the following must be turned after your submit your application:
*Recent Well Child Exam
*Recent Dental Exam (1 yr+)
*Immunization Report/or Exempt Letter
*Parent/Guardian ID
*Child Insurance Information
*Medical Documentation if Necessary
*Student Schedule or ID Number

If you have any questions, please call our office at 253.589.5531

***If you have multiple children you would like to place on the wait-list, please fill out an additional application and submit it***

* 2. What is your CPTC Student ID

* 3. Child Information

* 4. What is your relationship to the child?

* 5. Parent Information

* 6. Primary Contact Information

* 7. Secondary Parent/Guardian Contact (If Applicable)

* 8. When do you need care to start?

* 9. Is your child currently in care? If yes, where? (select all that apply)

* 10. Does any of the following apply to your child? (select all that apply)

* 11. Does your child have, or is in the process of getting: (select all developmental criteria that applies)

* 12. Health and Development (select all that apply)

* 13. How will monthly childcare costs be paid?

* 14. How did you hear about our program?

* 15. Current Living Situation (select all that apply)

* 16. What is your education level? (select all that apply)

* 17. Are you currently in the following? (select all that apply)

* 18. Parent Information (select all that apply)

* 19. What programs/support on campus are you using? (select all that apply)

* 20. What is your CPTC Program?

* 22. What was your CPTC Start Date? What is your tentative Graduation Date?

* 23. Are you done with your Pre-Req's?

* 24. Financial Aid Status (select all that apply)

* 28. Do you have any questions or additional information you would like to share with us? Please indicate them below: