KidsLife - Enrollment Inquiry

Parent First Name

Parent Last Name

Phone Number

Email

Message

LifeChurch Partner
Yes
No

Please fill out below for each child you wish to enroll.

Child's Name

Child's DOB

Potty Trained
Yes
No

Anticipated Year of Kindergarten

Desired Start Date

Desired Schedule

Hours

Child Two Name

Child Two DOB

Child Two Potty Trained
Yes
No

Child Two Anticipated Year of Kindergarten

Child Two Desired Start Date

Desired Schedule

Child Two Hours

Child Three Name

Child Three DOB

Child Three Potty Trained
Yes
No

Child Three Anticipated Year of Kindergarten

Child Three Desired Start Date

Child Three Desired Schedule

Child Three Hours