Kid's Place Learning Center Registration Form
Registration Form- This form is to add your name to our waiting list for enrollment. This form is only considered complete when you pay the $100 registration fee.
Date Registered
*
-
Month
-
Day
Year
Date
Parent's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Desired Start Date
*
-
Month
-
Day
Year
Date
My Products
prev
next
( X )
Registration Fee
This is fee is to hold your place on our waiting list for enrollment.
$
100.00
Credit Card
Submit
Should be Empty: