Child Development Laboratory Waitlist Application

Please fill out the information below. When this application is received, the child's name will be placed on the Child Development Laboratory Waiting Lists as indicated.Each age group has a separate wait list. Be sure to check the boxes of the corresponding program you would like your child on the wait list for. We will accept 3/4 of each school group for each lab on the basis of the application date. We will accept the remaining 1/4 of each group based on other specific criteria (referrals from medical professionals, etc). Please keep in mind that many children have been on the wait lists since birth so the lists are VERY long.

*Required

Child Information

*Child First Name:

*Child Last Name:

Child Gender:

Boy
Girl

*Child Birthdate:

*Check all age groups applicable (plan for the future):

Infant/Toddler (Entering Age: 6 Months - 24 Months)
Two-Year-Old (Entering Age: 2 - 2 years 9 months)
Three-Year-Old (Entering age: 3 - 3 years 9 months)
Four/Five-Year-Old (4 years+, cannot be attending Kindergarten)
Summer Four/Five-Year-Old (Four years+, cannot be attending Kindergarten)

Family Contact

*Parent/Guardian 1 Name:

Parent/Guardian 2 Name:

*Address:

*City:

*State:

*Zip:

*Primary Phone #:

Secondary Phone #:

*Email:

*Preferred Contact:

- Select - Phone Email

Submit Application