Enrollment Form
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Enrollment Form
Kid Kam

New Enrollment Special

18-24months (toddlers) 100.00
2-4yrs 90.00
School age 70.00
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Enrollment Application

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First Name Middle Name Last Name
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Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
bulletE-mail*
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- Area Code Phone Number
bulletSocial Security #
bulletDL # or ID #
bulletRelationship to child*
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First Name Middle Name Last Name
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Month Day Year
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 / Month  / Day Year Pick a Date
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Monday Tuesday Wednesday Thursday Friday
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From To
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Tell us a little about your child

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Breakfast Am Snack Lunch Pm Snack Dinner Eve Snack
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Going Potty Dressing Eating Washing Hands
bulletPlay Habits
Favorite toy, Activty fun things your child likes to do
bulletEating Habits
Favorite food,dislikes, willing to try new things?
bulletSleep Habits
Does child sleep with a toy, blanket or other item
bulletWhat fears does your child have
bulletPlease Enter your name to Acknowledge you understand the current page*
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Who can pick up your child

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 For divorced parents: The Children’s Playhouse must be provided with court issued custody papers that clearly describe the custody arrangements.  Any person granted custody in such papers may pick up the child during the times that person has custody and may designate other persons who are authorized to pick up the child at such times, unless court paper state otherwise

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Married Divorced Single
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Both Mother Father Guardian
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Yes No
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First Name Middle Name Last Name
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Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
bulletE-mail
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- Area Code Phone Number
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Name and phone # who can pick your child up

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First Name Last Name
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- Area Code Phone Number
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First Name Last Name
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- Area Code Phone Number
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First Name Last Name
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- Area Code Phone Number
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Please list who we may contact in case of a emergency when parent can not be reached

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First Name Last Name
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- Area Code Phone Number
bulletE-mail
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First Name Last Name
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- Area Code Phone Number
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First Name Last Name
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- Area Code Phone Number
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bulletShould be Empty:

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  Last Edited 08/08/2016