Child Care Instructions

1. Home and Family Information
Parent(s)' name(s) [list any parents who live at this address; other parents may be listed under Emergency Contacts]:
Names of Children: ______________________
Address:	__________________________
__________________________
Home phone number: ______________________
Other contact numbers at home (cell phone, pager, email): ______________________
2. Parent(s)' Work Information
[list name and address of employer, work phone number, and regular work hours for each parent]
______________________________________________
3. Temporary Contact Information
[specify the address and phone number where  you can be reached at a temporary location, such as a restaurant, movie, or friend’s house, plus the times you will be at each location]
______________________________________________
4. Child's Personal and Care Information
[provide the following information for each child]
Name of child: ______________________
Date of birth: ______________________
Allergies and other medical conditions: ______________________
Medications: ______________________
Meals, naps, and bedtime schedule: ______________________
Other comments: ______________________
5. Child’s Health Care Providers
[list names, addresses, and phone numbers]
Doctor: ______________________
Dentist: ______________________
Other medical providers: ______________________
6. Emergency Contacts
[list names, addresses, and phone numbers of people who babysitter can contact if they can’t reach you in case of emergency; specify their relationship to your family, such as children’s aunt or neighbor]
IN CASE OF EMERGENCY, CALL 911.
7. Other Important Information
____________________________________________________________________