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Contact Information:
Parents Full
Names:
1
2
House Address: Address:____________________________
City:_____________ State:_____
Zip-code:_____________
House Phone # (_ _ _) - _ _ _ - _ _ _ _
Where parents
will be?
Phone number
parents can be
reached at?
1 (_ _ _) - _ _ _ - _ _ _ _
2 (_ _ _) - _ _ _ - _ _ _ _
What time the
parents will be
back?
_______, ___, 2014 ; __ : __
Emergency Information:
Parents can be reached at? (_ _ _) - _ _ _ - _ _ _ _
Neighbors Number(if necessary) (_ _ _) - _ _ _ - _ _ _ _
Grandparents or Close Relatives (_ _ _) - _ _ _ - _ _ _ _
Local Police / Fire (911)!!
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Child(ren) Information:
Name:
Age:
Gender:
Medication: (if yes, please explain how
many doses any what time taken)
Any Allergies: (if yes, explain what and
how you prevent it)
Name:
Age:
Gender:
Medication: (if yes, please explain how
many doses any what time taken)
Any Allergies: (if yes, explain what and
how you prevent it)
Name:
Age:
Gender:
Medication: (if yes, please explain how
many doses any what time taken)
Any Allergies: (if yes, explain what and
how you prevent it)
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Rates:
$10.00/ Hour
I will make sure your child(ren) are safe the whole time they
are on my watch!
My #1 priority is your childs safety!! Your child will play
games, have fun, do arts & crafts, go hide & seek and much
more
while Im babysitting! While safety is my priority having fun
will also be another! I don't want to be the
babysitter the kids says didnt play with us, yelled at us the
whole time, wasn't fun, I want to be the one they say made me
laugh, we played fun games, I want him to babysit again! During the
time I babysit your child(ren), they will be in good hands, we will
pick up
after our self's, make the house nice and clean! Instead of
doing these activities in boring
ways we will make games and contests and have fun with it!
I can also make them dinner, if necessarily! Also, put them into
bed!
Okay enough of me telling you what Ill do and let me tell you a
little bit about me!
Let me tell you a little bit about me!
My name is Nicholas Rosselli. I am 13 years old and in the
7th
grade! I have straight As & Bs . I am good with cooking,
cleaning up, and much more! My hobbies are riding my bike and
playing soccer! I like to make crafts, play board games, and I can
help out with
homework! I have gone to a 3-hour Babysitting course as of: May
16, 2014!
This Included
-#1 THE SAFETY OF THE CHILD(REN)!!
-CPR, Choke Save, First Aid, and the basics of babysitting
-Diapering
-Bedtime
-Feeding/Dinner
-Fire Safety
-Discipline
**Certificate attached LAST PAGE**
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Questions:
1. Would you like me to feed the child(ren) ? (if yes, what food
and what time) :
________________________________________________________________________
2. Still wearing diapers? Yes or No (if yes, I change them!)
________________________________________________________________________
3. When is bedtime? Any rules? Any specifications (like keep
light on or door open a crack?)
________________________________________________________________________
4. Handling the phone...would you like me to take messages? Any
specifications?
________________________________________________________________________
5. Entertaining the kid(s)...can they watch t.v./ movie? **ONLY
G & PG**
________________________________________________________________________
6. Any areas in the house off limits for kid(s) or ME?
________________________________________________________________________
7. Is it OK to watch TV or listen to music at low level while
kids are in bed? (**Answer only for night shifts**)
________________________________________________________________________
8. Do you have any pets I need to feed or take care of? (I yes,
explain amount of food or how to take care of?)
_______________________________________________________________________
9. (Depending on time of Day) Can the kid(s) be outside! **NO
FRONT**
________________________________________________________________________
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10. Would you rather them put on sunscreen and/ or insect
repellent?
________________________________________________________________________
11. Kids Allergic to anything, or taking medication?
________________________________________________________________________
12. Do they have any illness I should be aware of?
________________________________________________________________________
If you would like to add anything, please do so below:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Cut this out and keep!
If you have any questions I can be reached at:
Name: Nicholas Rosselli
Cell: (774) 417 - 1266
Email: [email protected]
