General Information:

Our names: 
Our address: 
Nearest cross street: 
Our home phone #: 

We'll be at: ________________________________   Phone #: _________________________   


How to contact us:

*Mom

Work #:                            
Cell #: 

 *Dad

Work #:                            
Cell #:


In an emergency and if we cannot be reached, contact:

Name: 
Relationship: 
Telephone #: 		 Name: 
Relationship: 
Telephone #: 


Emergency numbers:

  • Poison control: 
  • Police dept.: 
  • Fire dept.: 
  • Pediatrician: 


Health insurance:

Insurance company:
Group/policy #:		 Policy holder's name:
Policy holder's ID #:


Children's Information:

1) Child's name:                                          * Child's Age:            * Nap or bedtime: 
* (Input here: bedtime routine, food allergies, medical conditions, etc.)

 
2) Child's name:                                          * Child's Age:            * Nap or bedtime: 
* (Input here: bedtime routine, food allergies, medical conditions, etc.)

 

Sitter Checklist courtesy of: www.rexanne.com