Preschool and Daycare on Truman Rd in Jasper, IN

Parent/Guardian Information

Child's Information

If you're enrolling more than one child, you may enter their information in the Miscellaneous Information section below.

Emergency Contact Information

Please add at least one emergency contact other than yourself.

Billing Information

The undersigned hereby authorizes Kid City USA to enter a charge to and to receive payment from the credit card account identified below for a one-time registration char ($100.00 for one child or $150.00 for families of two or more) to reserve my spot in their program.

I understand that Kid City USA will require a separate authorization form for any future credit card transactions and that this authorization is only applicable for the specified one time charge.

Card Type: VisaMastercardAmerican Express

How many children are you enrolling? One Child - $100.00Two or More - $150.00

Miscellaneous Information

When would you like to start?
"I understand that by filling out this form it does not guarantee my child's enrollment at this location and that this location must confirm my child's enrollment before beginning service. Additional documentation will be required upon enrollment."