Babysitter Checklist

Phone Numbers where we can be reached:


If you can't reach us then in an Emergency Contact:

At this phone number:

Doctor's Name:

Doctor's Phone Number:

Hospital Phone Number:

Allergies to:

Permission is Granted:

In case the parents of _____________________________ cannot be reached, then __________________________ hospital has the permission to treat
______________________ with note to the allergies listed above.
The insurance company to call is: ________________________________
with policy number being __________________
and their emergency phone number is: ________________________________

Signed: _____________________________ (parent/guardian)
Date: __________________

Special Notes about playtime, bathtime and food allowed:
______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ 

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