Enrollment Inquiry

Child
Enrollment
Application

Complete the application below and we'll be in touch within one business day to confirm your child's spot.

Phone(877) 565-5343

Emailschool@kaleidoscopekdc.com

HoursMon–Fri, 6am–5pm

Child in a warm home learning environment

Kaleidoscope Kollege In-Home Learning & Daycare

Child Enrollment Application

Enrollment Date

Program Start Date

Classroom

Infant (6 weeks–12 months)Toddler (1–2 years)Preschool (3–5 years)Before/After CareSummer Program

Section 1

Child Information

Child's Full Legal Name *

Preferred Name / Nickname

Date of Birth *

Gender

Primary Language

Home Address

City

State

Zip

Child Lives With

MotherFatherBoth ParentsGuardianFoster Parent

Other:

Drop-Off Time

Pick-Up Time

Section 2

Parent / Guardian Information

Parent / Guardian #1

Full Name *

Relationship to Child

Home Phone

Cell Phone *

Work Phone

Email *

Employer

Address (if different from child's)

Parent / Guardian #2 (optional)

Full Name

Relationship to Child

Home Phone

Cell Phone

Work Phone

Employer

Address (if different from child's)

Section 3

Emergency Contacts

Individuals who can be contacted if parents cannot be reached.

Emergency Contact #1

Name

Relationship

Phone Number

Authorized for Pick-Up?

YesNo

Emergency Contact #2 (optional)

Name

Relationship

Phone Number

Authorized for Pick-Up?

YesNo

Emergency Contact #3 (optional)

Name

Relationship

Phone Number

Authorized for Pick-Up?

YesNo

Section 4

Authorized Pick-Up Persons

Individuals authorized to pick up this child. Photo ID required for all pick-ups.

Person #1

Name

Relationship

Phone Number

Person #2 (optional)

Name

Relationship

Phone Number

Person #3 (optional)

Name

Relationship

Phone Number

Photo ID Required for All Pick-Ups

Section 5

Medical Information

Primary Physician

Physician Phone

Dentist

Dentist Phone

Health Insurance Provider

Policy Number

Allergies

NoneFood AllergiesMedication AllergiesEnvironmental Allergies

Medical Conditions

AsthmaDiabetesSeizuresAutismADHDOther

Current Medications

Section 6

Developmental & Learning Information

Has your child received services for any of the following?

Speech TherapyOccupational TherapyPhysical TherapyABA ServicesEarly InterventionIEP504 PlanOther

Section 7

Dietary Information

No RestrictionsVegetarianVeganDairy-FreeGluten-FreeReligious RestrictionsOther

Section 8

Toileting Information

DiapersPull-UpsPotty TrainingIndependent

Additional Notes

Section 9

Sleep Information

Nap Schedule

Comfort Items Allowed

Section 10

Emergency Medical Authorization

In the event of an emergency, I authorize Kaleidoscope KDC staff to obtain emergency medical treatment for my child if I cannot be reached immediately. I understand every reasonable effort will be made to contact me.

YesNo

Parent/Guardian Signature

Date

Section 11

Medication Authorization

I authorize Kaleidoscope KDC to administer medication as prescribed and according to written instructions.

YesNo

Parent Signature

Date

Section 12

Photo & Video Consent

I grant permission for my child's photograph or video to be used for:

Classroom Activities OnlyParent CommunicationSocial MediaMarketing MaterialsNo Permission

Parent Signature

Date

Section 13

Field Trip Permission

I authorize my child to participate in supervised field trips and community activities.

YesNo

Parent Signature

Date

Section 14

Tuition Agreement

Program Selected

Full-TimePart-TimeBefore CareAfter Care

Weekly Tuition ($)

Registration Fee Paid ($)

Payment Method

ACHCredit CardCashCheck

I understand tuition is due according to the Kaleidoscope KDC Parent Handbook.

Parent Signature

Date

Section 15

Parent Handbook Acknowledgement

I have received, read, and agree to comply with the policies and procedures outlined in the Kaleidoscope KDC Parent Handbook.

Parent Signature

Date

Before Your Child's First Day

Required Documents Checklist

Please submit the following before your child's first day. Check each item as you prepare it.

Additional Notes or Questions

Fields marked * are required. We'll respond within one business day. Your information is kept private.

Ready to Enroll?

Pay & Secure
Your Spot

Select your program below to pay your first week and lock in your child's enrollment. All rates billed weekly.

Ages 0–3

Infant & Toddler

$500–600per week

Full-time in-home care for infants and young toddlers, ages 0–3.

Pay Now →

Ages 3–5

Pre-K Program

$400per week

Curriculum-based Pre-K learning for children ages 3–5.

Pay Now →

Flexible

Part-Time Care

$50per hour · billed daily

Flexible hourly care for families who need part-time support.

Pay Now →

Virtual

Virtual In-Home

Contact Usfor pricing

Remote learning and support delivered directly to your home.

Pay Now →

Add-On

Toiletry Package

$375per month

All essential toiletries and supplies included — nothing to bring.

Pay Now →

Questions about payment? Call us at (877) 565-5343 or email school@kaleidoscopekdc.com

ChildEnrollmentApplication

Child Enrollment Application

Child Information

Parent / Guardian Information

Emergency Contacts

Authorized Pick-Up Persons

Medical Information

Developmental & Learning Information

Dietary Information

Toileting Information

Sleep Information

Emergency Medical Authorization

Medication Authorization

Photo & Video Consent

Field Trip Permission

Tuition Agreement

Parent Handbook Acknowledgement

Required Documents Checklist

Pay & SecureYour Spot

Infant & Toddler

Pre-K Program

Part-Time Care

Virtual In-Home

Toiletry Package

Child
Enrollment
Application

Pay & Secure
Your Spot