Harbor Kids Learning Center Application

Thank you for your interest in HKLC!

Submit the form below, and your child will be placed on our wait list.

Harbor Kids Learning Center Application

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

(###)

###

####

Parent/Guardian Primary Language

Child Name

Only one child per form.

First Name

Last Name

Child Birth Date

YYYY

Potty Training

Program

School Attending

(if not applicable, type None)

Child Primary Language

Child Care Hours

Please enter the desired hours for child care.