Flocknote

Wait List Application

- Enrollment
  - Tuition and Fees
  - Wait List Application

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- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Birthdate REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Parent 1 Full Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Occupation REQUIRED Please fill out this field. Please enter valid data.
- Parent 2 Full Name Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- Email Please enter an email address.
- Occupation Please enter valid data.
- Start Date: REQUIRED Please fill out this field. Please enter valid data.
- How many days a week do you want your child to attend school? REQUIRED Please fill out this field.
- *4 day schedule must include one Monday or Friday
  
  *3 day schedule must include at least one Monday or Friday
- First Choice of Days REQUIRED Please fill out this field.
- Second Choice of Days REQUIRED Please fill out this field.
- The $50.00 application fee must be paid (check or money order only) in order for us to accept this application.
  
  Make check payable to: Saint Gerard Majella Church
  
  Send check to: Saint Gerard Majella Children's Center at 4461 Inglewood Blvd. Los Angeles, CA 90066
  
  Spaces can become available at any time and we cannot hold a spot. If you wish to delay your enrollment, you will be required to pay the full month or months in order for us to reserve your space.
- Notes:
- Signature REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
Submit

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