Clone of PRISMS Child Care Registration Form

Invoice Number

We are delighted to announce that KiddieCorp will be hosting PRISMS Child Care during the 2026 Conference.

With forty years of experience, KiddieCorp has been a trusted provider of high-quality children's programs and youth services for conventions, trade shows, and special events.

KiddieCorp's longstanding partnership with the American Academy of Pediatrics has played a key role in establishing us as a premier provider of children's program services. Our commitment to caring for your children is our top priority, ensuring they not only have fun but also receive excellent care.

CHILD CARE DETAILS

Location:

DoubleTree by Hilton Hotel Bloomington - Minneapolis South

Minneapolis, Minnesota

Ages:

4 years through 18+ years old

Ratios for children affected by Smith-Magenis Syndrome:

1:2 for children 6 months through 18+ years old

Ratios for Neurotypical children:
1:2 for children ages 6 months through 11 months old
1:3 for children ages 1 through 2 years old
1:5 for children ages 3 through 5 years old
1:7 for children ages 6 through 12 years old

Daily Rates:

Thursday, July 30th - 1:00 p.m. to 5:00 p.m.

$70.00 per child

Friday, July 31st - 7:45 a.m. to 12:15 p.m. and 12:45 p.m. to 5:15 p.m.

$140.00 per child

Friday, July 31st - 8:00 p.m. to 10:00 p.m.

$35.00 per child

Saturday, August 1st - 7:45 a.m. to 12:15 p.m. and 12:45 p.m. to 5:15 p.m.

$140.00 per child

Registration deadline: Prior to July 9, 2026

We encourage early registration as availability is limited and operates on a first-come, first-served basis. To secure advance reservations, both the registration form and full payment must be received by KiddieCorp. On-site registration will be limited to available space.

MEALS/SNACKS

Snacks and water will be provided.

ACTIVITIES
Activities include exciting themes, arts & crafts, group games, music & movement, board games, story time, dramatic play, etc. We tailor activities to suit each age group appropriately.

TEAM MEMBERS

Our goal is to provide your children with a comfortable, safe, and happy experience. KiddieCorp team members are selected according to their integrity, experience, education, and enthusiasm. Every program has a CPR/First aid certified manager that is on site at all time.

REGISTRATION TERMS AND CONDITIONS

Additional information for parents:

KiddieCorp staff does not administer medication, including sunscreen.
KiddieCorp staff will not perform diapering procedures on children above the age of five years old.
Please label your child's belongings. While we maintain a lost and found, KiddieCorp does not assume responsibility for lost or stolen items.
Parents with infants, kindly bring diaper changing supplies, formula/baby food, and a change of clothes for your child's comfort.

NEED MORE INFORMATION?

KiddieCorp is available to answer any questions. Feel free to contact KiddieCorp by phone at (858) 455-1718 or by e-mail at info@kiddiecorp.com.

Parent Name*

First NameLast Name

Parent Name

First NameLast Name

E-mail Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How many children will you be registering?*

Child 1 First Name*

Child 1 Last Name*

Gender*

Age *

Child 2 First Name

Child 2 Last Name

Gender

Age

Child 3 First Name

Child 3 Last Name

Gender

Age

YesNo

If yes, please write the name of the affected child(ren).

Please be as detailed as possible.

Please list specific information about your child that will be useful in assisting us to provide proper care and to plan appropriate activities for the children who will be attending the program. Be sure to note any information relating to additional needs or applicable labels or diagnosis of which we should be aware.*

Please list any health problems that your child is currently experiencing or has a history of experiencing.*

My child is completely toilet trainedMy child is partially toilet trained, needs to be reminded to goMy child needs some assistance using the toiletMy child needs complete assistance/supervision in the restroomMy child is not toilet trained at all (wears diaper/training pants)

How often does your child need to be taken to the restroom?*

How does your child let you know that he/she needs to go to the restroom?*

Please list any other of your child's favorite activities, hobbies, or personal interests:*

Has typical attention span and level of activity for his/her age.Is easily distracted by sights, sounds, people, etc. and generally does not spend much time on a single activity.Has a short attention span, can self-manage simple tasks.Is underactive/needs motivation to participate in activities.Is overactive, needs very specific instructions and parameters set. May require more direct supervision.

Please describe how you manage your child's functional level, motivate him/her to participate, etc.*

Please indicate how often, if ever, your child does the following behaviors and consequences. Please be as specific as possible.

Rows	N/A	Seldom	Often	What you do when this occurs:
Bites self
Scratches, pinches, or hits self
Bangs own head
Aggressive toward others
Has seizures

Does your child have any fears? If so, what does he/she fear? What upsets your child?*

What helps calm your child when he/she is sad, hurt, afraid, or upset?*

Does your child have any limitations?*

Will there be any equipment accompanying your child? (Such as hearing aids, walker, wheelchair, etc.)*

Is there any additional information that may help us care for your child? Please be as specific as possible.*

YesNo

Day Rates:

Thursday, July 30th - 1:00 p.m. to 5:00 p.m.
$70.00 per child

Friday, July 31st - 7:45 a.m. to 12:15 p.m. & 12:45 p.m. to 5:15 p.m.
$140.00 per child

Friday, July 31st - 8:00 p.m. to 10:00 p.m.
$35.00 per child

Saturday, August 1st - 7:45 a.m. to 12:15 p.m. & 12:45 p.m. to 5:15 p.m.
$140.00, per child

KiddieCorp accepts MasterCard, Visa, American Express, & Discover.

Payment in full is required to confirm your reservation. Please make sure to bring a photo ID with you to the children's program. A photo ID will be required for check-in and check-out of children.

Thursday, July 30th - 1:00 p.m. to 5:00 p.m. *

Friday, July 31st - 7:45 a.m. to 5:15 p.m. *

Friday, July 31st - 8:00 p.m. to 10:00 p.m. *

Saturday, August 1st - 7:45 a.m. to 5:15 p.m.*

Additional Information

Number of Children Attending

Cost Per Hour

Total Fee(Hidden)

Total*

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Cancellations must be made to KiddieCorp prior to July 2, 2026 for a full refund. Cancellations made after that date will be subject to a 50% cancellation fee. Once the program has begun, no refunds will be issued.

Please list only the individuals authorized to check out the above child(ren) from the KiddieCorp children's program, including parents/guardians:

(Please list name and relationship; photo ID will be required when checking out children):

How many people are authorized to check-out the above child(ren)?*

Contact 1 Information*

Name:Relationship:

Phone Number

Area CodePhone Number

Contact 2 Information

Name:Relationship:

Phone Number

Area CodePhone Number

Contact 3 Information

Name:Relationship:

Phone Number

Area CodePhone Number

Contact 4 Information

Name:Relationship:

Phone Number

Area CodePhone Number

Emergency Contact Name:*

Emergency Contact Phone Number*

Area CodePhone Number

We, the undersigned adults, agree to place our child or ward in the KiddieCorp children’s program. For ourselves, our child/ward (or children/wards), and each of our respective heirs, assigns, and next of kin, we hereby release and agree to indemnify and hold harmless KiddieCorp, Parents and Researchers Interested in Smith-Magenis Syndrome, and their respective officers, directors, agents, employees, assigns, vendors, and the owners and/or lessors of the facility or facilities where the program will be held (collectively “the Releasees”), from any and all claims which may now or hereafter arise from our child’s/ward’s (or children’s/ward’s) participation in the KiddieCorp program. We do not release claims arising from Releasees for any of their willful misconduct or gross negligence.

Photographs taken throughout the children’s program may be used for promotion and/or publication by Parents and Researchers Interested in Smith-Magenis Syndrome and KiddieCorp, Inc.

We have read the above and understand this release. Furthermore, in the event of an emergency or health concern, KiddieCorp has our permission to administer first aid, contact our pediatrician, or obtain emergency medical treatment for our child. We agree to pay all expenses incurred due to an emergency involving our child.

KiddieCorp reserves the right to limit participation of any child whose presence or behavior may disrupt the program or endanger the health and safety of others.

Signature*

PRISMS Childcare

Parent Information

Child(ren)'s Information

Program Fee

Dates & Times

Payment Information

Cancellation Policy

Authorized Pick Up

Emergency Contact

Liability Release