Simply Kids Waiting List Form
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Enrollment Information
Requested Enrollment Date 
 *
MM
/
DD
/
YYYY
If flexible, please indicate an estimated time frame 
Preferred location  *
If either, please indicate your preference
Requested days  *
Child Information 
First and Last Name
Date of Birth (or Expected Due Date) *
MM
/
DD
/
YYYY
Gender
Clear selection
Parent/Guardian Information
First and Last Name
 *
Relationship to the Child
Contact information 
Phone Number 
 *
Email Address *
Submit
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