My Kidzone Waitlist/Drop In Form

My Kidzone Waitlist/Drop In Form

Your information will be placed in our database, and we will contact you as openings become available on a first come first serve basis.
Parent(s) Name(s)*
Student's Name and DOB*
Email Address*
Contact Number*
Emergency Contact*
Emergency Contact Phone Number*
Do you receive Text at this number?*

YesNo
Student's Gender*

MaleFemale
Student's Birthday*
Has child ever attended a childcare facility?*

YesNo
If yes, please list reason for facility change
Allergies*
What are some things the staff should know about your Child/children to better service your family?*
Address*
City*
Zip Code*
Please Select your Preferred schedule*

part timefull timeDrop In
Please Select your Preferred payment method*

cashCCAPzelleApple Pay
There is a $100 registrationfee/ & $50 supply fee, per family, due twice a year. This can be paid in person, or online thru the student portal. **Tuition is due on or before the first school day of each week. If payment is not received by pick up time late fees will be assessed. Tuition and all fees will be discussed at time of registration.
We occasionally take pictures of the kids in action with the materials or doing other activities for our website and/or blog. We hope to use these to keep parents up to date on the happenings at school.
Please click yes if you WILL give permission to have photographs of your child taken*

YesNoOnly for my personal update/emails etc.
How did you find us?*

SignFlyerGoogle/Other search engineInstagramFacebookFriendHometown ValuesOther
If you were referred by a friend please let us know who, so we can thank them!
Parent/Guardian signature

Clear
Should be Empty: