Waiting List Enrollment HRG-UCLCC Helen R Godfrey - University Child Learning & Care Center Name _____________________________________ Date: _____________________ Address _______________________________________________________________ City ______________________________________ State ______ Zip Code ________ Telephone: Home ______________________ Work __________________________ E-Mail Address: ________________________ Cell Phone ______________________ Children’s Name Age Birth date or Due Date _________________________________ ____ ___________________ _________________________________ ____ ___________________ _________________________________ ____ ___________________ Affiliation with the University (please circle one below) Student–Full Time Student-Part-time Faculty/Staff Indicate the type of care you need: _______ Full Time Alumni _______ Part-time Please list the hours care is needed for each day below: Monday Tuesday Wednesday Thursday Friday __________ __________ __________ __________ __________ When do you need to care to begin (i.e. ASAP, next semester, summer, date etc.) ______________________________________________________________ Please return completed form to: University of Wisconsin Child Care HRG-UCLCC-Delzell Hall 910 Fremont Street Stevens Point, WI 54481 **Placement on the waiting list is not perpetual. At the end of each academic year (each May), children’s names will be removed from the waiting list. If you would like your child to remain on the waiting list you must send or email a new completed Waiting List Enrollment form. The form can be found on our website at: www.http://uwsp.edu/childcare.