REGISTER ONLINE
SCHEDULE A TOUR

Filling out the online registration form will speed up the registration process but does NOT guarantee your child’s enrollment. You must meet in person with the center director to complete the process.

GENERAL INFORMATION

All fields in this section of the form are required.

FAHER INFORMATION

Fathers Employment Information

MOTHER INFORMATION

Mother Employment Information

3RD PARTY PERSONS INFORMATION

Persons (other than parents) designated to pick up child and may be called in case of illness or emergency. Must be at least 18 years old.

Person 1

Person 2

Person 3






CHILD HEALTH ASSESSMENT

Does your child have any known allergies or sensitivities to:

Medications*

Foods*

Other*


Screenings for Chronic Illness or Medical Conditions

Does your child have any of the following? Please mark yes or no:

Asthma

Visual Impairment

Diabetes

Developmental Delays

Seizures

Physical Impairment

Heart Problems

Behavioral or Emotional Problems

Hearing Impairment


Submit


Coming Soon!!!

At this moment we are not accepting applications online but if you wish to save a spot for your child, please contact us at 423-402-0521 or you can email us at administration@kidsrock.biz Thanks!!


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