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ENROLL
CINCINNATI EAST SKIDADDLES

Please fill out the enrollment form below and submit your enrollment fee on the following page. Once you are enrolled at one Skidaddles, you can use all of our locations for no additional enrollment fee!

Here’s all we need to get you started in addition to the form below. Please note, we will need a medical statement for all children enrolled under the age of 6 and a care plan for any child with an allergy.

CINCINNATI EAST ENROLLMENT FORM

Enrolling Parent/Gardian Name

Relationship to Child

Parent/ Guardian Email

Parent/ Guardian Phone

Employer

Home Street Address

City

Region/State/Province

Postal / Zip code

Second Parent/ Guardian Name

Second Parent/ Guardian Email

Relationship to Child

Second Parent/ Guardian Phone

Home Street Address

City

Region/State/Province

Postal / Zip code

Employer

CHILD INFORMATION

Child Name

Gender

Birthdate

Check any that apply

Allergies

Dietary Restrictions

Health/ Medical Condition

Special Conditions

Please explain any additional information concerning your child

I have another child to register

Second Child Name

Gender

Birthdate

Check any that apply

Allergies

Dietary Restrictions

Health/ Medical Condition

Special Conditions

Please explain any additional information concerning your child

I have another child to register

Third Child Name

Gender

Birthdate

Check any that apply

Allergies

Dietary Restrictions

Health/ Medical Condition

Special Conditions

Please explain any additional information concerning your child

EMERGENCY INFORMATION

Parents cannot be listed as emergency contacts. In the event of an emergency and I am unable to be reached, I authorize the following person/s to pick up my child(ren). At least one person must be within one hour of the center/home and should be at least 18 years of age.

Emergency Contact Name

Relationship To Child

Phone

Emergency Contact Name

Relationship To Chid

Phone