Enrollment | Kidz Kingdom PDHC

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818-759-0055

admin@kidzkingdompdhc.com

Is My Child Eligible?

For a child to be eligible for care, they must be under the age of 21.

Also the child must also be medically fragile/special needs.

Please complete this form with as much information as possible.

Name

Phone

How old is your child?

Does your child have any of the following diagnoses and/or conditions?

Asthma

G-Tube

Tracheostomy Tube

Neurological Disorders

Seizures/Epilepsy

Oxygen/Ventilator Dependent

Cerebral Palsy

Juvenile Diabetes

Congenital Abnormalities and Diseases

Other

If you checked Other, please write the diagnosis/condition.

Please write down any medications, vitamins, ointments, etc. that your child is taking.

Is there anything else you would like us to know about your child?

Would you like a tour of the facility? *

Yes

If Yes, please write down the days and times that work best for you.

How did you hear about us?

Thanks for reaching out. We’ll get back to you soon.

Funding

Funding for services at Kidz Kingdom is done through your health insurance. If you don't have insurance, our team can assist you in applying for Medi-Cal.

If you have any questions, feel free to contact us!

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Kidz Kingdom PDHC

13022 Sherman Way

North Hollywood, Ca. 91605

The information provided on this website is for general informational purposes only and is not intended to substitute professional medical, therapeutic, or legal advice. While Kidz Kingdom is committed to providing high-quality care and support for children with special needs, we recognize that every child’s needs are unique.

818-759-0055

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