Registration Main Form

Mason Registration

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 Parent Handbook
One-time Registration fee of $75 per family
Medical Statement (within 7 days of registering if younger than 6)
Care Plan (for special health conditions if applicable)
Medication Request (for emergency medication only, if applicable)

!!! IMPORTANT !!! – If your Primary Skidaddles Location will be Florence, KY., you CAN NOT use this form! You MUST use the FLORENCE, KY. Registration form!

Step 1 of 7

Parent/Guardian Information:
Enrolling Parent/Guardian Name:*
Relationship to Child:*
Address:*
Street Address Address Line 2 City State ZIP Code
Home Phone:*
Work Phone:*
Work Address:*
Street Address Address Line 2 City State ZIP Code
Cell Phone:*
Email*
Where can you be reached while your child is at Skidaddles?*

Parent/Guardian 2 Information:
If Parent/Guardian 2 Information is unavailable, please click Next on the bottom of the page.
Other Parent/Guardian Name:
Relationship to Child:*
Address:
Street Address Address Line 2 City State ZIP Code
Home Phone:
Work Phone:
Work Address:
Street Address Address Line 2 City State ZIP Code
Cell Phone:
Email
Where can you be reached while your child is at Skidaddles?*

Child's Information:
Name of child 1*
Birth Date*
MM slash DD slash YYYY
Gender*
Child 1 allergies?*
Allergy information or anything we need to know.*
Potty Trained?*
1
- Add another child?
Name of child 2
Birth Date
MM slash DD slash YYYY
Gender
Child 2 allergies?
Allergy information or anything we need to know.
Potty Trained?
2
- Add another child?
Name of child 3
Birth Date
MM slash DD slash YYYY
Gender
Child 3 allergies?
Allergy information or anything we need to know.
Potty Trained?
3
- Add another child?
Name of child 4
Birth Date
MM slash DD slash YYYY
Gender
Child 4 allergies?
Allergy information or anything we need to know.
Potty Trained?
4
- Add another child?
Name of child 5
Birth Date
MM slash DD slash YYYY
Gender
Child 5 allergies?
Allergy Information
Potty Trained?

Emergency Contact Information 1:
Contact must be local to the center.
In the event of an emergency and I am unable to be reached, I authorize the following persons to pick up my children:
Name:*
Home Phone:*
Cell Phone:*
Address*
City State / Province / Region
Relationship:*
-
- Add another contact?
Emergency Contact Information 2:
Contact must be local to the center.
Name:
Home Phone:
Cell Phone:
Address
City State / Province / Region
Relationship:

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.
Enrolling Parent/Guardian Name 1:*

Please enter full name.
Signature*
Today's Date:*
MM slash DD slash YYYY
Enrolling Parent/Guardian Name 2:

Please enter full name.
Signature
Today's Date:
MM slash DD slash YYYY