Kids Junction - Information Request Form

Personal and Contact Information:
Parent First Name:	Parent Last Name:
Phone:	Best Time to Reach You by Phone:
email:	Current Preschool/Child Care Situation:


Child 1 DOB:	Child 2 DOB:
Estimated Start Date - Child 1: Immediate 2 Weeks 1 Month Other:	Estimated Start Date - Child 2: Immediate 2 Weeks 1 Month Other:
Desired Program - Child 1: Infant (6 weeks - 12 months) Toddler (1-2 years) Preschool (2-3 years) Pre-K Half-day Preschool Before/After School School Age Summer Camp	Desired Program - Child 2: Infant (6 weeks - 12 months) Toddler (1-2 years) Preschool (2-3 years) Pre-K Half-day Preschool Before/After School School Age Summer Camp
Full Part Time: Full-time Part-time Before After: Before School After School Before & After School	Full Part Time 2: Full Time Part Time Before After 2: Before School After School Before & After School
School :	School :
Schedule Notes:

Additional Information:

How did you hear about Kid's Junction:

How did you hear about Kid's Junction - Other:

Additional Comments/Questions:

Information Requested:

Curriculum

Tuition Rates