CHIKIDS REGISTRATION/INFORMATION FORM

I am interested in the following option for my child:

___ Traditional Childcare Program 

___ Technology Option (child must be 3 years or older to participate) 

___ CHIkids Junior Leader (child must be 9 years or older to participate)

For children 5 years and older, prices range from $20-35 per half day.

For infants to five years of age, prices range from $35-40 per half day.


CHI Parent Name                 Date

_______________________________ ____________________

Address:

____________________________________________________


____________________________________________________


Phone Number: ______________________________________


Child's Name                    Age

_______________________________ ____________________



Print out this form and mail or fax to:

KiddieCorp
5665 Oberlin Drive, Suite 102
San Diego, CA 92121 
Fax: +1 619-455-5841