Kids Care Academy Waiting List Application

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Please fill out the form below to add your child(ren) to our waiting list.

* Indicates required question

First Name *

Your answer

Last Name *

Your answer

Phone Number *

Your answer

Email Address *

Your answer

Name(s) and Age(s) of Child(ren) *

List One Child Per Line

Your answer

Choose a Location *

Choose

Jeffersonville, Indiana

New Albany, Indiana

Either Location is Acceptable

Date You Would Like to Begin *

MM

/

DD

/

YYYY

Submit

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