Waitlist Sign-up Form – Backup

LJUMCNS maintains a dated waitlist for parents interested in our programs. Please complete the form below and submit the non-refundable $50 registration fee to join the waitlist. Parents are responsible for keeping the school apprised of any changes in contact information.

Licensed by the California State Department of Social Services
Facility #372000312, Cottage Facility #376600959

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Child's Name*

First Last

Child's Date of Birth*

Second Child's Name

First Last

Second Child's Date of Birth

Parents Name*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Today's Date*

How did you hear about us?

Special requests or notes for staff.

Wait List - One Time Fee Per Family*

Price:

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Total

Disclaimer: The payment of $50 is required in order to place your child on the waitlist, this payment and submission of waitlist form does not guarantee enrollment for your child.

Please contact the Nursery School if you would like to arrange a tour of our facility.