Parents Instructions for Babysitter

Children:

1. ________________     Age: _____     Naptime/Bedtime: ____________

2. ________________     Age: _____     Naptime/Bedtime: ____________

3. ________________     Age: _____     Naptime/Bedtime: ____________

4. ________________     Age: _____     Naptime/Bedtime: ____________

5. ________________     Age: _____     Naptime/Bedtime: ____________

 

Meals / Snacks

 

ALLERGIES: ______________________________

 

Breakfast:

 

Snack:

 

Lunch:

 

Snack:

 

Dinner:

 

Snack:

Special Rules:

(example:  Do not take kids outside)

 

 

 

 

 

 

 

 

 

 

Special Activities

(example:  Watch movie @ 7:00pm)

 

 

 

 

 

 

 

 

Things Children are

NOT Allowed to Do:

(Things your child does frequently that you need to let the babysitter know to watch for and stop. 

Example:  Play with Computer/Jump on Bed)

 

 

 

 

 

 

 

 

Information for the Babysitter

House Information

Family Name:

House Address:

House phone number:

Parent Information

MOTHER

FATHER

Where at:

Time home:

Cell number:

Alt number:

Where at:

Time home:

Cell number:

Alt number:

EMERGENCY CONTACT NAME & NUMBER:

 

Medication Instructions:  *It is recommended that no medication be administered by a babysitter.  Administering drugs is a serious responsibility and a babysitter should not be required to do so unless ABSOLUTELY NECESSARY.*

If ABSOLUTELY NECESSARY:

Child:__________________      Medication Name:______________      Dosage:__________________

Time(s) to be given (As needed is NOT an acceptable response): ­­­­­­­­_______________________________

EMERGENCY SITUATION-  CALL 911 FIRST

Police Station:

Hospital:

Sheriff’s Dept:

Doctor (name/number):

Fire Dept:

Poison Control (NC): 1-800-222-1222