Get started today with Skoober.

Responsible Party Info

First Name
Last Name
Email
Start Date
Username
Password
Date of Birth
Address
Mobile Phone
Home Phone
Work Phone
License Number
License State
Number of Registrants
  • 1
  • 1
  • 2
  • 3

Child Info

Child's Name
Date of Birth
Preferred Pickup Time:
Pick-Up Location/Business Name
Pick-Up Address
Pick-Up Contact's Name
Drop-Off Location/Business Name
Drop-Off Address
Drop-Off Contact's Name

Health History

Medical Conditions
Medication
Allergies
Allergy Medication
Doctor's Name
Doctor's Address
Doctor's Phone

Health Insurance

Do you have health insurance?
Insurance Provider
Provider's Phone
Subscriber's Name
Group/ID Number
Effective Date
Subscriber's Relationship to Registrant

Child Info

Child's Name
Date of Birth
Preferred Pickup Time:
Pick-Up Location/Business Name
Pick-Up Address
Pick-Up Contact's Name
Drop-Off Location/Business Name
Drop-Off Address
Drop-Off Contact's Name

Health History

Medical Conditions
Medication
Allergies
Allergy Medication
Doctor's Name
Doctor's Address
Doctor's Phone

Health Insurance

Insurance Provider
Provider's Phone
Subscriber's Name
Group/ID Number
Effective Date
Subscriber's Relationship to Registrant

Child Info

Child's Name
Date of Birth
Preferred Pickup Time:
Pick-Up Location/Business Name
Pick-Up Address
Pick-Up Contact's Name
Drop-Off Location/Business Name
Drop-Off Address
Drop-Off Contact's Name

Health History

Medical Conditions
Medication
Allergies
Allergy Medication
Doctor's Name
Doctor's Address
Doctor's Phone

Health Insurance

Insurance Provider
Provider's Phone
Subscriber's Name
Group/ID Number
Effective Date
Subscriber's Relationship to Registrant

Emergency Contact Info

Emergency Contact Name
This person will be contacted in the event we are unable to reach the Responsible Party.
Relationship to Registrant
Mobile Phone
Home Phone
Work Phone
Have any of the adults listed above been convicted of a sex offense?
By signing below I certify that all information is true and correct to the best of my knowledge.

Terms

Skoober’s commitment to providing safety starts with us but requires our passengers to honor the rules set in place to ensure the safety of each child. We believe communication is key and ask that you go over our Discipline Conduct prior to your child’s first Skoober experience.

The 1st incident results in a verbal warning and an email notification to the responsible party.

The 2nd incident results in being written up, an email notification and a call to the responsible party.

The 3rd incident results in a 3-day suspension from riding privileges, an email notification and a call to the responsible party.

Upon the rider’s return from the suspension, any further violations shall result in termination.

At anytime a law has been broken this incident will result in an immediate termination.

No refunds due to suspensions or termination of the contract.




Signature of Responsible Party
Signature of Passenger/Child

Authorization and Waiver to Transport Child

Child’s Name: (Last, First, MI)
Child's DOB
My child requires a booster seat
All children under 8 years of age are required to be in a booster seat
I authorize Skoober LLC., to transport my minor child in a company Van, driven by an individual authorized by Skoober LLC., I understand my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or staff or volunteer. I understand participation in the identified event is not a requirement for participation in the program.

I have read, understand, and discussed with my child:

(1) My child will travel in a motor vehicle driven by an adult and my child is to wear their safety belt during travel;

The 3rd incident results in a 3-day suspension from riding privileges, an email notification and a call to the responsible party.

(2) My child is expected to listen to supervising staff/driver, respect staff and other children, the vehicles they ride in, and the people they travel with during the trip;

(3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and,

(4) My child is to remain in their seat and not be disruptive to the driver of the vehicle.

Initial Each Statement:


I recognize participation in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify I have been advised of the potential risks, and I have full knowledge of the risks involved in this activity, and I assume any expenses incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses.
As a condition for the transportation received, I, for myself, my child, my executors and assigns, further agree to release and forever discharge Skoober, and their agents, officers, employees and volunteers from any claim that I might have myself or that I could bring on my child’s behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation.
I have read this entire waiver and authorization form, I fully understand its terms and conditions, and I agree to be legally bound by its terms.
Parent/Guardian Name:
Parent/Guardian Signature