Contact Information
First Name
Last Name
Email
Phone
Child Information
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Additional Child
Is your child potty trained through nap time?
No
My child has medications that are required at care
Does your child have any allergies?
If Yes, please List Any Allergies
Name of Hospital preferred for emergencies (Can NOT be 'Any' or Closest' MUST write an actual name of a hospital
Additional Information
Which days of week is needed for care? Mark all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Desired Start Date
What Program are you interested in?
Full Time
What is your typical for drop off and pick up (ie 7:00am-4:0schedule 0pm):
Please check to confirm that you understand the following statements
I understand children will only be released to individuals Kiddy Kollege has written authorization for.
I understand that this form does NOT guarantee an opening, once submitted the facility will review and contact me to discuss vacancies
I understand that if there is an opening for my child(ren) I will be required to complete enrollment forms for each child
I understand that a deposit is required for families not starting within 14 days and also for families who choose to not use automatic payments
Message
Submit
