Home School Application - KidzHOME

Prices (per child):

In a group of 5-8 kids – $25 per hour
In a group of 3-4 kids – $30 per hour
In a group of 2 kids – $35 per hour
Individual class 45 min – $50, 60 min – $60.

To get more info and/or to schedule a visit please contact us at 646 5084449 or 646 5084450 or send an email to info@kidzhome.org.

We will be happy to assist you.

Please fill out the application form below.

Educational Program Application

First Child Information

Child's First Name *
Child's Last Name *
Preferred Name
Date of birth *mm/dd/yy
Grade *
Food Allergies
Please specify

Second Child Information

Child's First Name
Child's Last Name
Preferred Name
Date of birth mm/dd/yy
Grade
Food Allergies
Please specify

Parent/Guardian Information

Parents/Guardians' Names *
Parents/Guardians' Email *
Parents/Guardians' Cellphone *
Parents/Guardians' Other Phone *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Emergency Contact *
Name and contact information in case of emergency
Persons Authorized to Pick Up Child *
Name, contact information. and relation to child

Parents/Guardians' Employment

Employment Name *
Occupation *
Work Phone *

Program Information

Time and Date *
Lessons *
Please write lessons you are interested in
Payment Method *
How did you learn about us?
Comments
Important information about your child that we should know. All information will be kept strictly confidential.
Signature *By signing this application I permit KidzHOME to take pictures/videos of my child(ren) and publish them on its websites and Facebook page, as well as in its publicity materials.

Coronavirus

Did the child(ren) or anyone else in the household experience COVID-19 symptoms in the past 14 days? *

Verification

Please enter any two digits *Example: 12
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