Bombeck Family Learning Center Waitlist Form
Child’s Name: ________________________________ DOB: __________________ Gender: ___________
Parent’s Name: ______________________________
Address: _____________________________________
City: __________________ State: _____ Zip: _______
PH#: ____________ Wk___________ Cell: _________
Email: _______________________________________
Enrollment Priority Ranking: Please check your affiliation with the University of Dayton
_______ 1. UD employee with one or more child(ren) presently enrolled
_______ 2. No affiliation with UD with one or more child(ren) presently enrolled
_______ 3. UD employee
_______ 4. UD student
_______ 5. UD alumni
_______ 6. No affiliation with UD
If UD employee department or office ________________________ Campus Ph# ___________________
Waiting List
PLEASE NOTE: Spaces are very limited and openings are rare. Due to the extent of our waiting list and large amount of
inquires we cannot respond to each request. We truly wish we could and most importantly offer all the children a spot
in our program. Due to the complexity of the waitlist process, which involves many factors we are unable to indicate
what number you are in the queue. You will be notified when we have an opening approximately 6 weeks prior to
enrollment. Again, we simply cannot answer every request. We apologize for the inconvenience.
Desire enrollment date: ___________________________________________
Parent Signature: _________________________________ Date Submitted: _________________
