Contact Us New Enrollment Make a request

To start the enrollment process, please complete the form below and click "next". Provide as much information as you can.

Important: You will be billed a $40 initial enrollment fee when you enroll. This fee is non-refundable and covers your membership for the calendar year. Membership renewal fee is $20 per year. For a printable version of our current rates and services in Adobe Acrobat (.PDF) version, click here.

Parent Information
Last Name
 First Name
 Home Phone [include area code]
Mobile Phone#
 Work Phone
 Ext:
Email Address
(Spouse) Last Name
 (Spouse) First Name
Mobile Phone#
 Work Phone
 Ext:

Address and Directions
Street Address

 City
 State
 ZIP
Driving Directions (From a major highway or downtown Louisville)

Children Information

Child 1		 Last Name
 First Name
 Gender
 Birthdate [ mm/dd/yyyy ]
 
Child 1 (Describe your child including any special needs)

Child 2		 Last Name
 First Name
 Gender
 Birthdate [ mm/dd/yyyy ]
 
Child 2 (Describe your child including any special needs)

Child 3		 Last Name
 First Name
 Gender
 Birthdate [ mm/dd/yyyy ]
 
Child 3 (Describe your child including any special needs)

Child 4		 Last Name
 First Name
 Gender
 Birthdate [ mm/dd/yyyy ]
 
Child 4 (Describe your child including any special needs)

Child 5		 Last Name
 First Name
 Gender
 Birthdate [ mm/dd/yyyy ]
 
Child 5 (Describe your child including any special needs)

©2004 - 2008 Sitters Service LLC. All rights reserved. To contact, call 502.254.2999 or email us.
P.O.Box 436354
Louisville, KY 40253