Waiting List — Step By Step Child and Family Center

Child’s Name (* indicates a required field)*

Date of Birth*

MonthDayYear

Boy:Girl:

Mother’s Name *

Phone #*

Cell/Other #*

Full Address*

Full Address 2*

E-Mail Address*

example@example.com

Father’s Name*

Phone #*

Cell/Other #*

Full Address*

Full Address 2*

E-Mail Address*

example@example.com

Alternate Contact Person (in the event you cannot be reached):

Name*

Phone #*

All applications are considered for full time daycare. As part-time spots are limited, a determination will be made upon acceptance.
Step by Step Child & Family Center (SBS) hours are 7:30 a.m.-5:00 p.m. daily for children aged 18 months to 4 years-old.
SBS is no longer able to accept waiting list applications from expecting parents, please submit the application after your child’s birth date.
Any outstanding daycare balances that parents have previously incurred from SBS, Seven Generations or Karihwanoron, must be paid in full before we can consider your application.

1) Please check all that apply: Are you currently employed?*

YesNoFull-TimePart-Time

Where are you currently employed?

Please check all that apply:

Attending School?Stay-at-home Mom?

Marital Status?*

Is the child living with both parents?*

YesNo

2) Describe your child and his/her strengths.*

3) Do you have any concerns about your child’s learning or development?

Explain

4)Are there any difficult behaviors requiring attention? (i.e. kicking, biting, scratching, pushing others etc.)

5) Have there been any major changes in the life of your family that may be affecting your child? i.e. a recent move, a death, a divorce/separation

6) Why do you want your child in Daycare?*

7) If you are planning on sending your child to a Kanien'kéha immersion school at 4 years of age, please select "yes" so we may place your child on the Kanien'kéha readiness waiting list. Please note that there are limited spots, while selecting "yes" does not automatically guarantee a spot in this classroom, we will do our best to accommodate your selection.*

YesNo

DOES YOUR CHILD HAVE...? If you answer “YES” to any of the following questions, please include explanation and treatment details. If additional space is needed please use the back of this sheet.

Explanations for #'s 12-15 above

I am responsible for notifying the center of any changes made to the information in this form regarding my child.

Signature*

Date*

Date

Please click the button below to send your information.

Parents/Guardians

PLEASE NOTE:

CONFIDENTIAL SCHOOL MEDICAL RECORD