Just Us
Kids Inc.
 
 

For general information or questions click here or for questions pertaining to wait list or available openings please fill out the form below.

Your Full Name
Your Email Address (e.g.: you@aol.com)
Relationship to Child (Choose One) 
Mother  Father  Grandmother  Other

Parents' home phone number (with country, city, area codes):

Father's work phone:  
Company:

Mother's work phone:  
Company:

Home Address:
City/Town: State/Prov.: Post./Zip Code:
Country:

Child's Name
Child's Gender (Choose One) 
Male  Female


Child's Date of Birth

Child's Physical Age (Choose One)
Infant
6-12 Months
13-18 Months
19-23 Months
24-29 Months
30-35 Months 
3 Years 
4 Years 
5 Years

Does your child have any special needs? Please be specific.

Do you have any Questions for us?

Thank you for your interest. We will process your inquiry as soon as possible.



 
© Copyright Just Us Kids Inc. 2006
Designed by CreativeWebVaues.com