Wait List Application

* Denotes required fields.

 

    Date: Hours of care for your child at KA:
    I hope my child can begin on:
    Child's Name:*

    First

    Middle

    Last
    Date of Birth:* Gender:*
    Child's address at starting date of enrollment:*
     
    MOTHER/Guardian's Name:* Age:*
    Mother's Home Address:*
    Mother's Home Phone:* Mother's Cell Phone #:
    Mother's Email:*
    Mother's Occupation: Work Schedule:
    Mother's Employer:
    Mother's Business Address:
    Mother's Work Phone #:
     
    FATHER/Guardian's Name:* Age:*
    Father's Home Address:*
    Father's Home Phone:* Father's Cell Phone #:
    Father's Email:*
    Father's Occupation: Work Schedule:
    Father's Employer:
    Father's Business Address:
    Father's Work Phone #:
     
    Name of person(s) who has legal custody of child:*
    List names and ages of other children living in the home:
    Does your child have any allergies (food, medications, etc?)*
    If yes, please specify and describe:
    What type of program was your child previously in?
     
    A NONrefundable application fee of $50 (per child) is required at the time of application
    When a spot may come available, Kid Angles will use this information to contact family. Kid Angles will make 3 attempts to contact said family, if NO response is received within 1 week of third notification then Kid Angles will remove application from the waitlist.