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Register

Registration is quick and easy! Simply submit the registration form below and we will have you set up and ready to go when you need us! Once you are registered at one Skidaddles, you can use all of our locations for no additional registration fee!

Here's all we need to get you started:

• Registration Form
• Signed Policies and Procedures
• One-time Registration fee of $40 per family
• Copy of Immunization Certificate (within 7 days of registering)

 

Parent/Guardian Information: Enrolling Parent/Guardian Name* : Driver's License : Relationship to Child : Email : Address : City : State : Zip : Home Phone : Cell Phone : Work Phone : Employer :         Parent /Guardian Name* : Driver's License : Relationship to Child : Email : Address : City : State : Zip : Home Phone : Cell Phone : Work Phone : Employer : Child's Information: Name of each child (Last if Different) Birth Date Sex Circle One Allergies Male Female Yes No Male Female Yes No Male Female Yes No Male Female Yes No Male Female Yes No Please explain any additional information concerning your child's allergies: What school district does or will your child(ren) attend? Emergency Contact Information: In the event of an emergency and I am unable to be reached, I authorize the following persons to pick up my children: Name : Relationship : Home Phone : Cell Phone : Name : Relationship : Home Phone Cell Phone Name Relationship : Home Phone : Cell Phone :   Name of Physician : Phone : Hospital Preference :     Consent for Medical Treatment: I give consent for Skidaddles to secure any and all necessary medical care for my child. Please Print Full Name :     Signature : Date : Please Print Full Name :     Signature : Date : How did you hear about Skidaddles Drop –In Anytime Kid Care? Check all that apply. Florence Recorder Drive-by Money Mailer Yellow Pages NKY Family Magazine Super Shopper Birthday Party Open House/Fair Flyer in Mail Yard Signs Family Matters Magazine Flyer Val Pak Internet/Search Engine Cincy Moms Like Me Website NKY Kids Connect Employee News Baseball Team Sponsorship Friend Who? We give gifts for referrals! Other Explain: By checking this box, you are agreeing with our Policies and Prodedures

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