Wait List Application

Child Information

Child's Name(Required)

First Middle Last

DOB(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Projected Start Date(Required)

Program(Required)

2's - Toddler

3's - Preschool

4's - Pre-K

Before/After School (Irving Elementary)

Non-School Days

Summer

Parent/Guardian (1)

Name(Required)

First Last

Home/Cell Phone(Required)

Work Phone

Is your home address the same as child's?(Required)

Yes

No

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Name(Required)

Work Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian (2)

Name

First Last

Home/Cell Phone

Work Phone

Is your home address the same as child's?

Yes

No

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Name

Work Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact (1)

Name(Required)

First Last

Relationship(Required)

Home/Cell Phone(Required)

Work Phone

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact (2)

Name(Required)

First Last

Relationship(Required)

Home/Cell Phone(Required)

Work Phone

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Address

Street Address Address Line 2 City State ZIP Code

Parent Information

Parent Name(Required)

First Last

Today's Date(Required)

Phone(Required)

Email(Required)

Admission Requirements(Required)

All of the following must be provided upon your child/children’s admission to the facility.

Select exactly 7 choices.

A completed Registration packet

A copy of your child’s up-to-date immunizations

A copy of your child’s most recent physical or completed Health Assessment form

A completed Federal Food Registration form

A completed Federal Food Program Eligibility form

1 month of paystubs

Signed Agreement Contract

CAPTCHA

Contact Us

Phone: (712) 258-1605

Email: meccp814@gmail.com

Location

814 Court Street
Sioux City, Iowa 51105

Business Hours

Monday – Friday
6am -5:45pm

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Wait List Application

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Parent Information

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