ASB Child Care Center
9600 College Way North
Seattle, WA 98103
206-934-3644
Waiting List Application
Date
Parent’s Name
Student ID#
Child’s Name
Child’s Date of Birth
Address
ZIP
E-mail address
Preferred Phone#
1. Children must be enrolled for at least 20 hours per week.
2. Parents must be enrolled for 10 credits or more at NSC.
3. We are open Monday – Friday 7:30 a.m. – 4:00 p.m.
What time do you need child care?
4. I would like care beginning:
Fall quarter 20__ 
Winter quarter 20__ 
Spring quarter 20__
 Summer quarter 20__
5. Will your child care be paid by any of the following?
 DSHS
 Seattle Milk Fund
 City of Seattle
 Self
Agreement
I understand that my child is being placed on the NSC’s child care waiting list. I
understand it is my responsibility to notify the center if my phone number or email
address changes. I understand that if I receive a phone call and/or email offering
my child a space at the center that I must respond within 3 business days. I
understand that failure to respond to an invitation to the center will mean that my
name will drop to the bottom of the list.
___________________________________
Signature
_____________________
Date