Wait List Application
Please submit a check or money order for $20, made out to Kaleidoscope Child Development Center.
You can mail checks to:
331 W. 13th Avenue
Eugene, OR
97401
We will process your application in the order it is received.
Today's Date
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DD
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Parent's Names *
Address *
Phone number(s) *
Email *
Child's Name *
Child's Date of Birth *
Desired Enrollment Date *
MM
/
DD
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YYYY
Desired Schedule
Does your child have any medical conditions or special needs that we should know about?
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