Wait List Application

Date of Application

Mother's First Name

Mother's Last Name

Date of First Attendance

Requested Schedule

• Full Time
• M-W-F
• Tu-Th

Child #1 First Name

Child #1 Last Name

Child #1 Nickname

Child #1 DOB

Child #1 Age

Choose One Infants - 6 weeks to 12 months Toddlers - 12 months to 24 months Twos - 24 months to 3 years Preschool - 3 years to 5 years Ready for 'K' - 5 years

Child #1 Gender

• Male
• Female

Child #2 First Name

Child #2 Last Name

Child #2 Nickname

Child #2 DOB

Child #2 Age

Choose One Infants - 6 weeks to 12 months Toddlers - 12 months to 24 months Twos - 24 months to 3 years Preschool - 3 years to 5 years Ready for 'K' - 5 years

Child #2 Gender

• Male
• Female

Mother's Address

City

State

Choose OneALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWADCWVWIWY

Zip

Mother's Cell Phone

Mother's Home Phone

Mother's Work Phone

Mother's eMail

Preferred email Method

HTML Plain Text

Father's First Name

Father's Last Name

Father's Address

City

State

Zip

Father's Cell Phone

Father's Home Phone

Father's Work Phone

Preferred Contact Method

• Cell Phone
• Home Phone
• Work Phone
• eMail

Preferred email Method

• HTML
• Plain Text

How did you hear about us?

Choose One Word of Mouth Yellow Pages Parenting Magazine Web Search Postcard Mailing Other (please describe below)

Other

Due to limited space availability, I understand that in order for my child to be placed on the Cambridge Academy Wait List, a $100 individual or $175 family non-refundable administration fee will be collected.  Should a space become available, I understand that this fee will be credited toward the annual registration fee.  Completion of this Wait List Application does not guarantee enrollment for my child, but confirms my interest in active enrollment.  Should my child be accepted for admission to Cambridge Academy, I understand that a deposit covering the first two weeks' tuition will be due in order to secure my child's enrollment.

Parent Acknowledgment

• Agree
• Disagree

REMINDER :

You must complete the security question below, and then click the "Submit Wait List Request Now" button at the bottom of this form to submit this application.

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