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: Does your child attend Westside, McRae, or SWMS?

School Age Only: Will your child need transportation to/from school or both? We ONLY drop off and pick up from 3 Searcy Public School's (Westside, McRae, SWMS)

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

Any allergies, developmental delays, or additional comments/information Daycare should be aware of:

Submit

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

Pay the Waiting list fee

HIS Kids Waiting List Application

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