LOCATION
Conference
Date     to
Hours to
Hotel Name		Check-In
CONTACT INFORMATION
Parent Name		How many Children?
What language(s) does your child speak?
Do you want to share a sitter with another family? If so, specify the name(s) of another family
Cell Phone		Alternate Phone
Email Password Confirm Password
BILLING (HTTPS: SECURED)
Credit Card Number	Expiration	Security Code
Billing Address	Zip Code
Will you pay cash or credit card at the end of your stay? Cash   Credit
ELECTRONIC SIGNATURE
Do you give permission for your child(ren) to be treated in the event of an emergency? Electronic Signature - this is your legal signature and confirms that you have read and agree to all policies and the Liability Release as stated herein. I give permission for a doctor to treat my child in the event of an emergency.
Electronic Signature - this is your legal signature and confirms that you have read and agree to all policies and the Liability Release as stated herein. I understand and agree to Super Sitters, Inc. terms and conditions.
User IP for Security Purposes 38.107.179.208
Date of Registration Sun May 20 2012 1:45 AM