Kid Champion Child Waitlist Application
Child's Full Name
*
First Name
Last Name
Child's Nickname
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent or Guardian
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Work Hours of Parent #1
*
*Days and Hours
Work Hours of Parent #2
*
*Days and Hours
Interested in...
Monday - Friday
Monday, Wednesday, Friday
Tuesday, Thrusday
Interested in... (Please select all that apply)
*
7:30AM Dropoff
8:30AM Dropoff
3:30PM Pickup
5:30PM Pickup
We are still working on getting pricing as well as an exact start date
Any additional comments?
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