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.