top of page

Home
About Us
- FAQ
- Contact Us
Programs
Playhouse
Parties & Events
More

Use tab to navigate through the menu items.

Membership

To apply for membership please complete all questions.

Child's Name

Child's Date of Birth

Address

Child's Parent / Guardian Name

Home Phone Number/Cell Phone Number/Alternative Number

Emergency Contact Name

Select an item ($)

Membership Fee - $89.99

Relationship to Child

Emergency Contact Number

Add another child

Child's Name

Child's Date of Birth

Child's Name

Child's Date of Birth

Child's Name

Child's Date of Birth

For Kid's Club Drop-In Care Purposes Only: Other than you, who else has permission to pick up your child?

Relationship to Child

Address

Home Phone Number/Cell Phone Number/Alternative Number

Add another person

Relationship to Child

Add another person

Child's Date of Birth

Child's Date of Birth

Child's Date of Birth

Relationship to Child

I give permission that my child(ren) may be given first aid/emergency treatment by a child care licensee and/or qualified staff at: Our Kid's Place LKN 115-J Commons Drive Mooresville, NC 28117

Signature

Date

Address

Home Phone Number/Cell Phone Number/Alternative Number

In case of an emergency, I give permission for any of the following individuals to be contacted and my child may be released to them.

Relationship to Child

Address

Home Phone Number/Cell Phone Number/Alternative Number

Address

Home Phone Number/Cell Phone Number/Alternative Number

© 2023 by Our Kids' Place LKN

Designed by The ShowKase Agency

bottom of page