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

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Gender

Home Address

City

State

Zip/Postal Code

Parent/Guardian's Phone Number

Parent/Guardian's Email

Preferred Start Date

Please select the session you are wanting to secure for your child:

Child Age Classification
Infant (6 wks to 18 months)
Toddler (19 months to 3 yrs)
Pre K (3 to 5 yrs)
School Age (K to Sixth Grade)

School Age Only: Elementary or Middle School Name

School Age Only: Will your child need transportation to/from school?

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:

HIS Kids Waiting List Application