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HIS Kids Waiting List Application
Child's First Name
Child's Last Name
Child's Date of Birth
Child's Gender
SELECT ONE:
Male
Female
Unknown
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:
SELECT ONE
Year Round (12 Months)
Summer Only
School Year Only (No Summer)
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:
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