Wait List Form Program AvailabilityCheck if appropriateDCYF/Foster Care ChildCurrently enrolled in the GBKC agencySibling currently enrolled in agencyEligible for NH Child Care Scholarship AssistanceAvailability will vary by site/program, by age group, and by daily attendance pattern.Parent/GuardianParent Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhonePlease indicate if you would like to be contacted to schedule a tour. Yes (If yes, you will be contacted via email within 5-7 business days) No ChildChild Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Anticipated Enrollment Date* Date Format: MM slash DD slash YYYY Please enter the month and year you are interest in having your child enrollAreas of InterestProgram Interested In Action Club Summer Camp Main Street Action Club Lincoln Street Action Club Newfields Action Club Exeter Center Pease Center Newmarket Center Age Group Interested In Infants Young Toddlers Toddlers Pre-school Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Scheduling Needs Monday Tuesday Wednesday Thursday Friday Hours (i.e. 8 am to 4 pm)How did you hear about our agency?Person filling out this form First Last CAPTCHA Please be aware there is a $75.00 Non-Refundable Fee to place your child on our Wait List which will be applied to Registration Fees when enrolled.