IRSC Child Development Center
Wait List Application
Date of Application: Preferred Start Date:
Child Information:
Child’s Full Name: Date of Birth: Sex:
Is the child potty trained? Yes No
(Please note that children must be potty trained to be eligible for our preschool program).
Sibling(s) currently attending IRSC center? Yes No
Name of Sibling(s):
Parent/Legal Guardian * Information:
* Legal Guardian status will need to provide appropriate documentation confirming relationship
status.
Parent/Legal Guardian * Name: Relationship: Email:
Address: City: State: Zip:
Home/Cell Number: Work/Other Number:
Parent Status: Full Time IRSC Student Part Time IRSC Student IRSC Faculty/Staff
Community School Readiness
I understand that my request for enrollment is valid for one year from the date of submission. I
further understand that my child’s admission date is dependent upon the following factors:
1.
Vacancy in the age appropriate classroom
2.
Parents entrance status
3.
Date that I signed and submitted the request
4.
My requested start date
5.
Potty training status of child for the 3 and 4 year old room
I also understand that IRSC’s Child Development Center cannot hold a place for my child, if
there is another child requesting an earlier start date, regardless of the request date made by
the child’s parents, the earlier date will have preference.
I agree to abide by the application, eligibility, vacancy, notification, and waiting list process
and all policies and procedures followed by IRSC. I understand this request in null and void if
all information is not completed.
Parent Signature: Print Name:
Date:
Staff Signature: Date Received:
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