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Accreditations
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Parent Referral Form
Parent Referral Form
Fill out the form below and we will contact you as soon as possible
—usually the same day.
New Full-Time Parents That Sign Up Using This Form Receive 10% Off Their 4th Month's Tuition*!
Title
*
Name:
*
Street Address:
*
City:
State:
*
Zip:
*
-All States-
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NJ
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OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
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WY
Work Phone:
*
Home Phone:
*
Email:
*
Your Childs Name:
*
Age:
*
Birth Date:
*
Sex:
*
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-Select-
Female
Male
What date would you like your childcare to begin?
*
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02
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YYYY
2025
2024
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2022
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2020
2019
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2016
2015
2014
2013
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2011
2010
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Please provide as much additional information as you can (e.g. What hours do you need? What days? Does your child have any special needs?)
*
To receive 10% discount, applicant must be a new full-time client and must stay with LKB for 3 months, upon which the discount will be refunded to the client.
Little Kids On The Block Inc.
728 South Naperville Road, Wheaton, IL 60189
(630) 462-9644
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