Child Development Center Waiting List Application Date: (required) Child's Name: (required) Child's Birth or Due Date: (required) Second Child's Name: Second Child's Birth or Due Date: Third Child's Name: Third Child's Birth or Due Date: Care Date: (required) Parent's name: (required) Home Phone Number: (required) Work and/or Cellphone Numbers: (required) Your Email: (required) Would you like a tour? (required) How did you hear about the First Church of the Brethren Child Development Center? (required) [recaptcha id:captcha] Click here for a printable form. Please mail or fax your completed application to the address/number listed on this form. Your child’s name will be placed on our waiting list. The receipt of this application does not guarantee enrollment into the Child Development Center. Thank you for considering us for your child care needs.