South End Children's Cafe Enrollment Waiting List

Thank you for your interest in the South End Children's Café.

Please be aware that we will contact you as soon as there is an opening position here at the South End Children's Cafe.

Any questions of concerns, please feel free to contact Shaletha Peppers, Senior Program Director, at 518.816.3099.

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Street Address:

City:

State:

Zip Code:

Cell:

Home:

Work:

Child's Name (If more than one child, please list all children with full names):

Child's Age (If more than one child, please list children's ages in order of names listed above):

Child's Date of Birth (If more than one child, please list children's birth dates in order of names listed above):

What school does your child attend (if more than one child, please list children's school in order of names listed above)?