Waitlist Sign-up Form

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

Child's Name*
First Last
Child's Date of Birth*
Month
Day
Year
Second Child's Name
First Last
Second Child's Date of Birth
Month
Day
Year
Parents Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Referred By
Today's Date*
MM slash DD slash YYYY
Special requests or notes for staff.
Wait List - One Time Fee Per Family Quantity*
Price: $50.00
Total
$0.00
Phone
This field is for validation purposes and should be left unchanged.

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.