Items marked with a red asterisk (*) are required.

    Child's Name:*

    Child's Birthdate:*

    Gender:*

    Desired Starting Date:*

    Desired Program:*

    Tuition Payment Method:*

    Desired Schedule Please check all time slots requested. We require a minimum of two days per week. All requests must be confirmed by the Hillcrest Kid's office before registration is final. Add special notes to the "Special Need/Requests" field below. Thank you.*

    MondayTuesdayWednesdayThursdayFriday

    Special Needs/Requests: (i.e. dietary requirements, scheduling needs, etc.)

    Your Contact Information:

    Child Lives With:*

    Your First and Last Name:*

    Your Email:*

    Address:*

    City:*

    State:*

    ZIP Code:*

    Employer:

    Phone:*

    Today's Date:*

    Referred by:

    Please Read: A Schedule Request is the first step in determining whether or not we have an opening for your child to attend Hillcrest Kids. We will contact you either by email or phone to let you know about availability. If you are offered the waiting list, your position in the wait-list will expire six months from the date of your inquiry. If and when you accept an opening in our program, you are responsible to pay a non-refundable $100 Annual Registration fee by a date set up by yourself and the scheduling manager. In addition, once the Registration Fee has been paid, you are responsible to give a two-week notice in the event you decide to withdraw from our program. Tuition is due before the first day of attendance. For families receiving state assistance (DSHS), the annual registration fee is also required when an opening is accepted. Once the state authorizes payment towards the fee, a credit will be applied to your account, which will go towards the amount of your monthly copay. DSHS students must wait to attend until Hillcrest Kids has received an award letter from the state.

    To accept the terms of this agreement and send your schedule request, please click on "Send."