06/09/2026
(240)-453-9790
(301)-801-2100

Wait List Form
Lyceum for Kids Daycare

Parent's First Name*:
 Parent's Last Name*:
Street Address*:
City*:
 State*:
 Zip*:
Home Phone*:
 Cell Phone:
e-Mail Address*:
 Work Phone:
Child's First Name*:
 Child's Last Name*:
Date of Birth (mm/dd/yyyy)*:
Childcare Locations:
(Check any of which you would like to attend)		 13544 Glen Mill Road
7801 Green Twig Rd
9000 16th St
11704 Rocking Horse Rd
906 Lewis Ave
309 West Diamond Ave
10000 McKenney Ave
Attendance Start Date: As Soon As Possible
Approx.Date (mm/dd/yyyy):
Attendance Schedule: Full Time
Part Time (describe):
How did you hear about us?
Comments: