Little Stars Application
Please nominate your preferred sessions in order of preference below. You may select any number of sessions however your child will be able to attend a maximum of two (2) sessions per week.
e.g. 1st Preference: Monday AM, 2nd Preference Wednesday PM
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Session Preference *
Required
Mother's First Name *
Your answer
Mother's Last Name *
Your answer
Mother's Contact Number *
Your answer
Mother's Email Address *
Your answer
Father's Full Name *
Your answer
Father's Contact Number *
Your answer
Father's Email Address *
Your answer
Helper's Name *
Your answer
Helper's Contact Number *
Your answer
Name of an elder sibling that has attended or currently attending City Kids
Your answer
Additional notes
Your answer
How did you hear about us?
Submit
Never submit passwords through Google Forms.
This form was created inside of Citykids.