Wilshire ECLC Waitlist Form

Submission

MonthDayYear

Wilshire Baptist Church
Early Childhood Learning Center
4316 Abrams Rd, Dallas, TX 75214
Tel: 214-452-3115 Fax: 214-452-3162
eclc@wilshirebc.org

Wilshire Early Childhood Learning Center
Waitlist Form 2020-21

Child's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

**Child must be 3 months on or before

August 31st 2019**

Parents' Name(s):*

Phone Number*

Area CodePhone Number

Email*

Age Group (on or before August 31st 2019)*

Infant-Toddlers/Twos - minimum of 1 day maximum of 3 days

Threes - minimum 2 days maximum 3 days

Pre-K - minimum 3 days maximum 4 days

Days 1st Choice*

Days 2nd Choice*

Days 3rd Choice*

Are you a member of Wilshire Baptist Church*

Are you a current ECLC Family*

Additional Comments i.e. flexibility regarding choice of days