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Child Information

Tell us about your child

First Name *

Last Name *

Date of Birth *

Gender

Is your child potty trained?

Yes No

Program *

Preferred Location *

Choose Open to both if you're open to whichever has availability.

Schedule Preference

Preferred Start Date

Preferred Drop-off / Pick-up Times (optional)

Kawai Kids hours of operation are 7am – 6pm.

Primary parent or guardian

First Name *

Last Name *

Email *

Phone *

Relationship to Child

Employer

Address

This helps us keep your child safe

Allergies

Medical Notes

Special Needs

Immunization Status

How did you hear about Kawai Kids?

Additional Notes

Please review the information below before submitting