Application — KiddiTime

Welcome to KiddiTime Family Childcare!

Thank you for your interest in our program. The form below is required for Tour Request, Waitlist, Enrollment, or Information Requests. Please complete a separate form for each child and click Submit. Once we received your form(s), we will email you additional information. If there are any technical issues or you don’t hear from us after 3 business days, please call us. We are here to help you so please contact us if there are any questions.

Phone: (630)403-8448
Email: kidditimeinfo@gmail.com

Child's Name

First Name

Last Name

Parent/Guardian

First Name

Last Name

Relationship to child

Parent/Guardian

First Name

Last Name

Relationship to child

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer / Address

Work Phone

(###)

###

####

Occupation

Child Age

Gender

Language spoken at home

Special Care

Please indicate if your child requires any special care and/or support.

Medications/OTC Products

List of current medications:

Allergies

List any allergies and reactions

Severe Allergies

Are any of the allergies severe or life-threatening? (If yes, please talk to us and provide an allergy plan.)

Desired Start Date

YYYY

Desired Tour Date

YYYY

Desired Daycare Option

How did you find us?

Flyer-where/Online-what website/Referral-who/Other-how?

Questions/Notes

KiddiTime

Hours

Connect