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HIS Kids Waiting List Application
Child's First Name
Child's Last Name
Child's Date of Birth or Due Date
Child's Gender
SELECT ONE:
Male
Female
Unknown
Home Address
City
State
Zip/Postal Code
Parent/Guardian's Phone Number
Parent/Guardian's Email
Parent First Name
Parent Last Name
Preferred Start Date
School Age Only: Elementary or Middle School Name
School Age Only: Will your child need transportation to/from school? We ONLY pick up from Searcy Public School District (Westside, McRae, Sidney Deener, SWMS)
Please list below any other Childcare Facilities your child has attended. Please include dates attended.
Any Allergies or additional comments/information Daycare should be aware of:
Submit
Click this link after you submit the above information to pay the $50 waiting list fee.
Pay the Waiting list fee
