Heavenly Kids Center for Learning Application Inquiry

400 East Mound Street, Columbus, Ohio 43215

You MUST Submit before leaving this form or ALL entries will be lost.

Child

Enter the child's full name (example: use Joseph not Joe)

First name *

Last name *

Preferred name 🛈

Gender *

Male

Female

Date of birth * +

Language spoken at home *

Enter the date you would like your child's attendance to start

Select the programs and days you would like your child to attend

⮚Preschool is for children from birth to age 5 on September 1

⮚Preschool is available for children in Head Start

Start date * +

Program *

Days *

Children must be registered for a minimum of 25 hours of care per week.

How did you hear about us? *

Title * 🛈

First name *

Last name *

Relationship to child *

Street address *

City *

State *

Zip Code *

Enter telephone number as 10 digits with no other characters

Primary telephone *

Type *

Email address *

Payment method *

Private pay

Title 20 "subsidized child care"

Infants	Toddlers	Preschool	Before school
After school	School closings	Summer camp