HIS Kids Infant/ Toddler Waiting List

Address *

Please select the session you need to secure for your child. *

Year Round (12 month) Summer Only School Year Only (NO Summer)
Parent's/Guardian's Name(s)

First Name Last Name
Parent's/Guardian's Name(s)

First Name Last Name
Home or Cell Number *

- Area Code Phone Number
Work Number

- Area Code Phone Number
Email
example@example.com
Signature

Clear
Should be Empty: