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Download this Babysitter Checklist Template that is created to keep your child care provider all of the information needed to properly care for your child(ren) in your absents.  All of the parental information and instructions may be entered into this checklist. It will also serve as a signed document for children to be medically treated in the event of an accident and parents are unable to be contacted.

How To Write

Step 1 – Section 1 – General Information –

  • Parent’s Names
  • Resident phone number
  • Home address
  • Cross streets

Step 2 – Section 2 – Contact Us –

  • Where we will be
  • Time expected home
  • Address where we will be
  • Cell phone number
  • Secondary cell number

Step 3 – Section 3 – Child(ren)’s Information

  • Names of children
  • Children’s DOB’s
  • Allergies- Special Needs (per child)
  • Mealtime
  • Bedtime
  • Allowable snacks
  • Additional Information and/or special instructions

Step 4 – Section 4 – In An Emergency –

  • *Call 911
  • Poison Control Number
  • Doctor Number
  • Neighbor’s Number
  • Relative’s Number
  • The location of our fire extinguisher

Step 5 – Section 5 – House Rules

  • TV and computer programs that are un/acceptable
  • Foods that are un/acceptable
  • Guidelines for outside play
  • Guidelines for inside play
  • Guidelines for company
  • Bedtime Routine

Step 6 – Section 6 – Food Guidelines –

  • Never leave a child unattended with food. Make sure any food given to a child under 4 years old is cut into small pieces (size of a fingertip). Avoid giving raisins, hot dogs, raw carrots, celery, grapes, nuts, hard candy, gum, popcorn, raw pears and apples to children under 4 years of age. For ages 4 to 6, be sure to peel and cube apples, pears, and carrots. Never drink or eat anything hot while holding a baby.

Step 7 – Section 7 – Parental Release-

  • Fill in the information with regard to permission for a sitter to allow or sign for medical care.
  • Parent or legal guardian should sign and date the document

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