Valley Baptist Church - Searcy, AR - HIS Kids Waiting List Application

HIS Kids Waiting List Application

Child's First Name

Child's Last Name

Child's Date of Birth or Due Date

Child's Gender

Home Address

City

State

Zip/Postal Code

Parent/Guardian's Phone Number

Parent/Guardian's Email

Parent First Name

Parent Last Name

Preferred Start Date

School Age Only: Elementary or Middle School Name

School Age Only: Will your child need transportation to/from school? We ONLY pick up from Searcy Public School District (Westside, McRae, Sidney Deener, SWMS)

Please list below any other Childcare Facilities your child has attended. Please include dates attended.

Any Allergies or additional comments/information Daycare should be aware of:

Submit

Click this link after you submit the above information to pay the $50 waiting list fee.

Pay the Waiting list fee

HIS Kids Waiting List Application

Our Story

What We Believe

Leadership

Contact Info