Wait List - My School

My School Wait List Application

Office Use Only:
Date app received _____________________
Deposit received_____________________
Child's Start Date_____________________
Child's End Date_____________________

CHILD INFORMATION

Full Name*

Gender*

Female
Male

DOB*

Interested in:*

Desired Start Date*

Age at Start Date*

Preferred Schedule- Specify T/TH, M/W/F or 5 days & hours*

Please give as much detail as possible. Which days work best? Are you looking for just the main program hours or do you need AM and/or PM ext day hours? How flexible is your schedule?

Current School (if any)

PARENT/GUARDIAN INFORMATION

Full Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone*

Cell

Work

Email*

2ND PARENT/GUARDIAN

Click box to show 2nd Parent/Gaurdian form

Full Name*

Address*

Same address as Parent/Guardian above
Different address

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone*

Cell

Work

Email*

Wait List Fee (non-refundable)*

Select one. Pay by check made out to "My School, LLC" mailed to 118 Locust Street, Dover, NH 03820.
Pay online through PayPal (include processing fee). My School will email you link after receiving receiving/reviewing the application.

I am mailing a CHECK for $40
Email me the link to pay online ($40 plus processing fee)

By signing below, I indicate my understanding of the following:

**By submitting the fee and this completed form, I have applied for a space for my child in at My School.

**while every attempt will be made accommodate my preferred schedule, my child’s schedule may differ from the one requested with this application and I will be offered a schedule that takes into account my request and the space available in the program.

Signature of Parent/Guardian*

Sign inside the box below.

Date*

Select Today's Date

My School is committed to a policy of equal educational opportunity and to the program of affirmative action in order to fulfill that policy. My School shall consider all applicants and their families without regard to unlawful criteria including race, color, religion, natural origin, sex, sexual orientation, disability, age, or status as a disabled or Vietnam-era Veteran, as these items are defined under applicable law.