Sauk Prairie Kids Companion Application

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This application will take between 15-25 minutes to complete. Once submitted, a Board Member will be in contact with you within a week. You may be asked for your social security number, which may be needed to run a background check as part of the application process.

Please ask your insurance agent to send confirmation of your auto and homeowners insurance coverage to Sauk Prairie Kids Companion, PO Box 1, Prairie du Sac, WI 53578

Personal Information:

Full Legal Name *

Date of Birth *

YYYY

Cell Phone Number *

Email Address *

Address/City/State/Zip *

How long have you lived at this address? *

If less than 5 years, previous address

Names and ages of those living in your home: *

Present health?

Any physical limitations?

Gender

Race

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