Kids ‘R’ Kids Apopka 301 West Welch Road Apopka, FL 32712 (407) 884-5621

WAITING LIST APPLICATION

Please complete the information below if you would like to be put on the waiting list for our school. A $25.00 non-refundable fee must accompany this form in order to be placed on the waiting list. Please contact us at the telephone number listed above if any contact information should change.

Today’s Date:

Requested Start Date:

Child’s Full Name:

Child’s Date of Birth:

Child’s Address:

Sex:

Male Female

Preferred Enrollment:

Full Time Part Time

If part time, 2 Day 3 Day

Is child potty trained?

Yes No

Preferred Program:

Infant One Two Three Four VPK Summer Camp

Before and After School Before School After School Name of School:

Mother’s Name:

Address:

Home Phone: Cell Phone: Work Phone:

E-mail:

Father’s Name:

Address:

Home Phone: Cell Phone: Work Phone:

E-mail:

Parent Signature: _______________________________________ Date: ____________________________

Office Use Only

Waiting List Fee Payment: $ Type: Date Received:

Date Contacted to Enroll: Start Date: Suite:

Notes: