Infant/Toddler Waiting List

for HIS Kids Christian Academy

Fill out the form below to register for a spot on our Infant/Toddler Waiting List. Please understand that your registration is not complete until you make your payment of $50 application fee online or to the HIS Kids office. Thank you and we look forward to seeing you!

 
Child's Name *
Child's Name
Child's Birth Date *
Child's Birth Date
Preferred Start Date *
Preferred Start Date
(If space allows)
Please select the preferred session you would like to secure for your Child. *
Parent/Guardian Name *
Parent/Guardian Name
Name of person to contact for enrollment information.
Parent/Guardian Name 2 (optional)
Parent/Guardian Name 2 (optional)
Address *
Address
Primary Contact Phone *
Primary Contact Phone
Parent Guardian Phone
Parent Guardian Work Phone
Parent Guardian Work Phone
Parent Guardian 2 Phone
Parent Guardian 2 Phone
Parent Guardian 2 Work Phone
Parent Guardian 2 Work Phone