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
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
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
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