Waitlist Application

  • Child's Information

  • Date Format: MM slash DD slash YYYY
  • Parent/Guardian Information

  • Please use Cal Poly email if applicable
  • Please use Cal Poly email if applicable
  • Name of ChildBirthdate of Child 
  • Income Information

    Income information is only required if a family is applying for subsidized childcare (low income). For specific information on what qualifies for subsidized care, please contact the Children's Center or review Qualifications for Eligibility:
  • Check all that Apply
  • Check all that Apply