Family Profile
How did you hear about us?
Mother's Information
Mother's Name
First Name
Last Name
Home Phone
-
Area Code
Phone Number
Cell Phone
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Area Code
Phone Number
Work Phone
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Area Code
Phone Number
Home Address
Work Name and Address
Father's Information
Father's Name
First Name
Last Name
Home Phone (if different)
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Home Address (if different)
Work Name and Address
Children's Information
Child 1
Name
Click to edit
Age
Allergies or Special Needs
Hobbies and Interests
Child 2
Name
Click to edit
Age
Allergies or Special Needs
Hobbies and Interests
Child 3
Name
Click to edit
Age
Allergies or Special Needs
Hobbies and Interests
Child 4
Name
Click to edit
Age
Allergies or Special Needs
Hobbies and Interests
Daily Routine
Daytime Routine (including snack time(s) and lunch time)
Evening Routine (including snack time(s) and dinner time)
Bedtime Routine (including snacks and bedtimes)
Acceptable Foods
Unacceptable Foods
House Rules
Rules for Inside Play
Rules for Outside Play
TV Programs that are unacceptable
Preferred Activities
Prohibited Activities
Other Guidelines
Sitter Preferences
Is the sitter permitted to drive your children?
Yes
No
Does the sitter need to have any of the following special skills?
Lifeguard Certified
Bilingual
Cooking skills
Tutoring
Musical instruction
Experience with learning disabilities
Experience with special needs
Other (specify below)
other special skill requested
Emergency Information
Doctor's Name/Group and Contact Information
Neighbor's Name and Contact Information
Relative's Name and Contact Information
Our fire extinguisher is located:
School Pickup
(only needed if sitter will be picking up child from school)
School 1
School Name and Address
Child(ren) being picked up
Activity to be picked up from
Pickup Time and Location
School 2
School Name and Address
Child(ren) being picked up
Activity to be picked up from
Pickup Time and Location
School 3
School Name and Address
Child(ren) being picked up
Activity to be picked up from
Pickup Time and Location
Medical Release
By typing my name and initials below, I certify that any licensed physician, dentist, or hospital may give necessary emergency medical service to my child at the request of the person bearing this form.
Health Insurance Provider
Policy Number
Parent or Legal Guardian's Full Name
*
Parent or Legal Guardian's Initials (to serve as electronic signature)
*
Electronic Signature
By typing my name and initials below, I certify that I have read, agree with, and am committed to adhering to the Terms of Service Agreement provided at the bottom of this form.
Full Name
*
Initials (to serve as electronic signature)
*
Submit
Terms of Service Agreement
By using services rendered through Executive Sitters, LLC, I understand and agree to the following guidelines: 1. I understand that sitters are independent contractors, not employees, therefore Executive Sitters is NOT responsible or liable for the sitter’s behavior at anytime. I understand that Executive Sitters is not responsible for situations that may occur while an independent contractor is in my home. 2. If I choose to allow an independent contractor to drive my children, I will NOT hold Executive Sitters responsible in the unlikely event that an accident occurs. 3. I will treat the independent contractors with dignity and respect at all times. 4. I will pay the agreed upon rate to the independent contractor that is stated on the website. 5. I will give an estimated time of return and will make every effort to return within 30-45 minutes of the anticipated time. If I am going to be significantly later than the estimated time, I will call the independent contractors to inform him/her of this change in time (i.e. 30+ minutes). 6. I will call/e-mail at least 24-hours before a scheduled job if I need to cancel. If I cancel with less than 24 hours remaining, there will be a $10 charge to be given to the independent contractors to compensate him/her for the time that he/she had committed. This fee may be waived by Executive Sitters depending upon the circumstances. 7. If I am dissatisfied with the performance of an independent contractor, I will first discuss it directly with him/her. I can request an evaluation form from the owner of Executive Sitters. If an independent contractor gets 2 negative evaluations, he/she will no longer be associated with Executive Sitters. 8. I understand that the success of Executive Sitters is based upon using the services rendered honestly and appropriately, therefore I will NOT share independent contractor contact information with others. 9. I will NOT contact the independent contractor for future babysitting needs on my own. I understand that he/she can only be booked through the Executive Sitters site. My electronic signature verifies that I have read, agree with, and am committed to adhering to each of the above guidelines. Failure to do so will result in my being unable to use Executive Sitters in the future and may result in a breach of contract claim against client.
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