Contact Info
2323 E St Bakersfield, CA 93301, USA
hilda@kidssteam.org
Mod-friday, 06am -02pm
+1 (661) 549-7908
Enroll Now
+1 (661) 549-7908
hilda@kidssteam.org
2323 E St Bakersfield, CA 93301, USA
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Child Information
Child’s First and Last Name
First
Last
Gender
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Date of Birth
MM slash DD slash YYYY
Does your child have an IFSP or an IEP?
IFSP (Individualized Family Service Plan, for children under 3)
IEP (Individualized Education Program, for children 3 and older)
No
Parent/Guardian Info
Parent/Guardian Name
Phone Number
Email Address
Address
Street Address
City
ZIP / Postal Code
Emergency & Medical
Emergency Contact (other than parent)
Name
Phone
Relationship
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Morning
Afternoon
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Preferred Start Date
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Permissions
I consent to my child’s participation in all activities.
I allow photographs/videos for educational & promotional purposes.
Signature
Parent/Guardian Signature
Date
MM slash DD slash YYYY
