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:
Work Phone:    Home Phone:    Email:
Your Childs Name:    Age:   Birth Date:    Sex:
What date would you like your childcare to begin?
*  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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