Kiddie Academy

CONFIDENTIAL
Kiddie Academy Domestic Franchising, LLC
Preliminary Questionnaire

Please provide the requested information and either
submit electronically or print and return by FAX to: 410.569.1448
Personal Information
First Name: Middle: Last Name:
Birth Date:
Home Address:
City: State: Zip: Email:
Home Phone: Mobile Phone: Business Phone:
Best Time to Call: Do you have children?
Ages of Children:
If married, spouse's name: Spouse's Birth Date:
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 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? 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 know any families that have children attending Kiddie Academy? If yes, which Kiddie Academy?
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
Assets Liabilities
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:
Real Estate Holdings:
  Address Current
Market Value		 Current
Mortgage Balance
Home:
Investment Properties: (1)
(2)
(3)

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 the following toll free number if you have any questions: 800.554.3343
Submit Application