Kids Inn Child Care Babies Day Inn Registration Form
Every child will need a separate registration form. 
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Parent/Guardian First & Last Name *
Email Address *
Phone Number *
Preferred Schedule (2 or 3 days a week) *
Required
Times *
Required
Months *
Required
Are you currently registered with Kids Inn Child Care? *
Infants Name *
Infants Medical Conditions/Allergies *
Infant Date of Birth *
MM
/
DD
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YYYY
Feeding Information  *
Required
Additional Info or Questions
I grant permission for Kids Inn to take pictures of my child and use them on their social media and other marketing materials. *
I, on behalf of myself, my spouse, and my child designated on the registration form hereby waive and release all rights, causes of action, and claims against Kids Inn, its Officers, Directors, and Employees, for any loss, expense, damage or injury suffered by my child during the time my child is visiting Kids Inn, including the possible negligence of Kids Inn, but excluding gross negligence and intentional misconduct. I understand that the provision of childcare contains a risk of injury to persons and damage to property and that by signing this release I engage Kids Inn to provide temporary childcare for my children at my own risk. I have been given an opportunity to inspect the premises of Kids Inn and found that it is safe and satisfactory for my child. I also have been given the opportunity to ask questions and obtain answers to my satisfaction regarding any and all aspects of Kids Inn and this Release. *
By signing this Release, I have not relied on any promises or statements made by Kids Inn or its employees other than those contained in written information supplied to me by Kids Inn. I understand this Release will be kept on file at Kids Inn and will continue in effect for this and any future visits my child may make to Kids Inn. *
I have read the above carefully and fully understand the content and consequences of this agreement and agree to abide by and be bound by the above policies and procedures and release. I have read and understand the Kids Inn parent handbook and will abide by all guidelines and rules. I acknowledge that I have received and read the Summary of Licensing Requirements. *
I/we grant permission for the staff of Kids Inn to take whatever steps necessary to obtain emergency medical care, if warranted. These steps may include, but are not limited to the following: 1. Administer minor first aid 2. Attempt to contact a person, guardian or emergency contact 3. Attempt to contact childʼs physician 4. Attempt to contact the parent through any of the persons listed above 5. If we cannot contact the parent or the childʼs physician, we will do any of the following: a. Call another physician b. Call an ambulance. c. Have the child taken to the emergency room in the company of a staff member in a staff vehicle. 6. Any expenses incurred under item “5” above will be borne by the childʼs family. *
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