Daycare Emergency Contact Form Printable Details

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.

QuestionAnswer
Form NameBabysitting Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschild care emergency form, child contact information form, child care emergency form sample, child care information form

Form Preview Example

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: _________________________

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