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*
" indicates required fields
Child's Name
*
Date of Birth
*
MM slash DD slash YYYY
Email
*
Father's Name
Cell Phone
Work Phone
Which Location(s)?
*
KSA Clemson
700 College Avenue
Clemson, SC 29631
KSA Anderson
117 Midtown Square
Anderson, SC 29621
KSA Anderson- New
515 Camson Rd. Building B
Anderson, SC 29625
Mother's Name
Cell Phone
Work Phone
Date Care Needed
*
MM slash DD slash YYYY
Does any of the child's siblings currently attend the center?
*
Yes
No
How did you hear about us?
Classroom Desired
*
Infant
Pretoddler
2K
3K
4K
Afterschool K-4th
Please check the appropriate box
Signature
*
Date
*
MM slash DD slash YYYY
Please note there is a $50 processing fee with each child waitlist application form. Please make checks payable to Kids Stuff Academy. The completion of this form does not guarantee a position for your child.
Payment Information
Address
*
Street Address
Address Line 2
City
Alabama
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Northern Mariana Islands
Ohio
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
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Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Waitlist Fee
Price:
Credit Card
*
Card Details
Cardholder Name
CAPTCHA
Untitled
First Choice
Second Choice
Third Choice
Email
This field is for validation purposes and should be left unchanged.