CPTC Staff 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

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***

What is your CPTC Staff ID?

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* 2. What is your CPTC Staff ID?

Child Information

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* 3. Child Information

What is your relationship to the child?

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* 4. What is your relationship to the child?

Primary Contact Information

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* 5. Primary Contact Information

Parent Information

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* 6. Parent Information

Secondary Parent/Guardian Contact (If Applicable)

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

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

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

When do you need care to start?

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* 9. When do you need care to start?

How will monthly childcare costs be paid?

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* 10. How will monthly childcare costs be paid?

Health and Development (Please select all that apply)

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* 11. Health and Development (Please select all that apply)

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

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

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

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

Where on campus do you work?

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* 14. Where on campus do you work?

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

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

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