The Babysitters Club Information Sheet

Child(s) Name:
______________/ ________________/_____________
Date of Birth
: _______/_____/______ (
_______/_____/______ (

)
)

Parents/Guardians Information
:
Name (First) ______________ Name (Last)_______________
Name (First) ______________ Name (Last)_______________
Email: __________________________________
Telephone Numbers
:
Home: ________-________-________
Cell: ________-________-________
Address
:
_______________________ City _____________ State_____ Zip Code
_____________
Emergency Contact Information
:
Name: _________________________
Telephone Number:____________________
Relation:_________________________
Allergies
:
YES

NO

________________________________
Medical History
:

Current Medications:_____________________
Medical Conditions/ Other :____________________________
If so how can we accommodate the child's needs?
Schooling/Education
:
Current Place of Education:________________________ Grade Level:_____
Pets/Animals at home
:
YES

NO

If yes specify what type (s) ? _______________________

Bedtime/Daytime Routine Hours

:
____________________________________________________________
Parent Information:
Occupation (Guardian 1): __________________
Occupation (Guardian 2):__________________

What sorts of things do the children enjoy/ food, games, etc:

____________________________________
____________________________________
____________________________________