CTK Kids LIT Application
Ages 15 & Under
LIT Applicant Name
*
First Name
Last Name
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent / Guardian email
*
example@example.com
Serving Frequency
*
Weekly
Bi-Weekly
Monthly
As Requested
Area of Service
*
Nursery (0-23 mo)
Adventureland (2-5yrs)
Base Camp (K-5th)
Flexible
Service Time
*
9:00am
11:00am
Reference #1
*
First Name
Last Name
Relationship to applicant
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #1 email
*
example@example.com
Reference #2 (Other than parent or guardian)
*
First Name
Last Name
Relationship to applicant
*
Reference #2 phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #2 email
*
example@example.com
Submit
Should be Empty: