A babysitting form is a document that outlines the guidelines for what to do in the event of an emergency. This includes who you are, your contact information, where you live and work, allergies/dietary restrictions (if any), any medication (prescriptions or over-the-counter) taken on a regular basis or special needs children might have. The purpose of this document is also to give parents peace of mind knowing they can entrust their children with someone they know will take care of them if anything happens. Having these forms available for easy access ensures that no matter the situation, all parties involved are prepared.
You may find info about the type of form you wish to complete in the table. It can show you the span of time you'll need to finish babysitting form, what parts you will have to fill in, and so forth.
| Question | Answer |
|---|---|
| Form Name | Babysitting Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | child care emergency form, child contact information form, child care emergency form sample, child care information form |
CHILD CARE EMERGENCY CONTACT INFORMATION AND CONSENT FORM
Child’s Name: ___________________________________________ Birth Date: __________________________________
Address: ___________________________________________________________________________________________
Parent/Guardian #1 Name: ____________________________________________________________________________
Telephone: Home ______________________Work ________________________Beeper/Cell _______________________
Parent/Guardian #1 Name: ____________________________________________________________________________
Telephone: Home ______________________Work ________________________Beeper/Cell _______________________
EMERGENCY CONTACTS (to whom child may be released if guardian is unavailable)
Name #1: __________________________________________________ Relationship: _____________________________
Telephone: Home ______________________Work ________________________Beeper/Cell _______________________
Name #2: __________________________________________________ Relationship: _____________________________
Telephone: Home ______________________Work ________________________Beeper/Cell _______________________
CHILD’S PREFERRED SOURCES OF MEDICAL CARE
Physician’s name: ___________________________________________________________________________________
Address: ________________________________________________________ Telephone: ________________________
Dentist’s name: _____________________________________________________________________________________
Address: ________________________________________________________ Telephone: ________________________
Hospital name: _____________________________________________________________________________________
Address: ________________________________________________________ Telephone: ________________________
Ambulance Service: _________________________________________________________________________________
Telephone: _________________________________
(Parents are responsible for all emergency transportation charges)
CHILD’S HEALTH INSURANCE
Insurance Plan: _______________________________________________________ ID # _________________________
Subscriber’s Name (on insurance card): _________________________________________________________________
SPECIAL CONDITIONS, DISABILITIES, ALLERGIES, OR MEDICAL EMERGENCY INFORMATION
__________________________________________________________________________________________________
__________________________________________________________________________________________________
PARENT/GUARDIAN CONSENT AND AGREEMENT FOR EMERGENCIES:
As parent/guardian, I consent to have my child receive first aid by facility staff and, if necessary, be transported to receive emergency care. I will be responsible for all charges not covered by insurance. I consent for the emergency contact person listed above to ACT ON MY BEHALF until I am available. I agree to review and update this information whenever a change occurs and at least every 6 months.
Parent/Guardian Signature: _____________________________________________ Date: _________________________
Parent/Guardian Signature: _____________________________________________ Date: _________________________