Kiddie Academy

Date: _________

VPFD: _________

PRES: _________

Kiddie Academy Domestic Franchising, LLC
Preliminary Questionnaire

Please complete the entire form and return by either submitting electronically below,
printing and return by FAX to 410.569.2729,
or by printing and EMAIL to
Personal Information
First Name: Middle: Last Name:
Birth Date:
If married, spouse's name:
First Name:
Last Name:
Spouse's Birth Date:
Home Address:
City: State: Zip: Email:
Home Phone: Mobile Phone: Business Phone:
Best Time to Call: Do you have children?
If so, age:
Will you have partners in the business? If so, name(s)? (please note, each partner must complete a separate application)
Business Experience/Education
Your Employer: Position: Annual Income:
Level of Education?
Major: Degree?
Have you ever owned a business? Have you ever owned a child care business?
Spouse's Employer: Position: Annual Income:
Spouse's Level of Education?
Major: Degree?
Are you or your spouse currently serving in the Military, or are you a Veteran?
Type of Discharge:
General Information
Have you or your spouse ever filed for personal or business bankruptcy protection?         Year:  Have you or your spouse ever been convicted of a felony or misdemeanor other than a minor traffic violation?

Are there any felony or misdemeanor charges pending against you?
In what country do you hold citizenship? If not USA, do you hold permanent resident status? Are you or your spouse a named party in any pending litigation?
Have any judgements been entered against you or your spouse or a business you control or did control?    Year(s):
How did you first hear about Kiddie Academy?
Have you ever visited a Kiddie Academy? If yes, where?
What is your timeframe for deciding on a Kiddie Academy franchise?
Have you visited Kiddie Academy's website?
Who will have the primary day-to-day responsibilities of operating your Kiddie Academy?
Do you plan on operating your Kiddie Academy on a full-time basis as your primary means of income?
What prompted you to inquire about a Kiddie Academy franchise?
Do you have a preferred area to locate your Kiddie Academy franchise? (town, city, county)
Financial Information
* Although initially not required, at some point, Kiddie Academy will require bank statements
and other documentation verifying the information contained below.
Assets (A) Liabilities (B)
Cash (checking and savings): Bank Loans:
Stocks & Bonds (excluding retirement): Mortgages (balances):
Real Estate (residence): Notes Payable:
Real Estate (investment): Credit Card Debt:
401(k): Margin Accounts:
IRA: Other (itemize):
Other (itemize):  
(A) Total Assets:   (B) Total Liabilities:
(A) Total Assets:
(B) Total Liabilities:
(A) MINUS (B) = Total Net Worth:
(C) Unused Line of Credit:
(D) Funds Available for Investment:
* Required Field
Real Estate Holdings:
  Address Current
Market Value
Mortgage Balance
Investment Properties: (1)

I/we understand that the information provided above will be material to the determination by Kiddie Academy Domestic Franchising, LLC (“Kiddie Academy”) whether I/we meet the eligibility requirements of the Kiddie Academy® franchise opportunity. I/we agree to promptly notify Kiddie Academy of any material changes to the information provided. I/we hereby certify that the information presented above is true and accurate, and understand that my/our application could be denied if any of the information provided is false or misleading. The submission of the information or acceptance of my/our application places no continuing obligation on Kiddie Academy.

I/we hereby release Kiddie Academy and its members, officers, directors and employees from any and all liabilities, claims and/or causes of action regarding the use or disclosure of the information presented above.

Applicant Signature Date
Co-Applicant Signature Date
Please call if you have any questions: 800.554.3343
L-12 ©2005-2018 Essential Brands, Inc. (08/15)
OFFICE USE: Date: _______________ VPFD: _______________ PRES: _______________