Childcare Information Form

Hi! This is just a little form that I send to the parent/guardian of a kid I'm providing childcare services for so that I can know some information beforehand! It makes it less stressful for you and will help me know exactly what I'll be doing. This also means that if I provide childcare for your family multiple times, I'll hav the information and won't have to bug you about it each time. This form should take about 5 minutes to complete since most of it's optional, but it would still be helpful! Let's run through each section: 1st section: I just need your email address, so you can access and update this online if you need to 2nd section: General required questions, so I know specifically what I'm doing 3rd section: Just some questions so I can get to know your kid(s) better! 4th section: A few more questions about my role, to be extra precise. 5th section: Only applicable if I will be driving your family around. Ready? Let's do this! Indicates required question

Email*

example@example.com

Required Questions:

General required questions so I know exactly what I'm doing

Whats your (adults/guardians) first name(s)?*

Whats your last name(s)?*

Whats your phone number(s)?*

5 Whats your home address?*

If I need to reach you:*

Text MeCall MeOther

Health and Safety:

Allergies or Medical Issues:*

Include dosages and times for medications

Location of emergency items*

Bandages, Benedryl, Epipen, First aid kit, etc

Children's Doctor's Name

I request your child's doctor's name, phone number, and address to ensure their safety while under mycare. This information enables me to promptly contact their doctor in case of a non-life-threateningemergency and to maintain accurate medical records

10 Childrens Doctors Phone Number

11 Childrens Doctors Address

Please Use:

SunscreenBug SprayOther

Are there any religious or cultural matters I should be aware of?*

Understanding and respecting your family's religious or cultural practices is important to me. Please provide any relevant information to ensure that your child feels comfortable and valued in my care.

14 At what point should I contact you if a disciplinary issue arises*

If there's an emergency, would you like me to contact you first or call 911 first?*

Contact me firstCall 911 firstUse your own judgement

What resources and contacts do you have if there is an emergency?*

Please provide a trusted friend or family member (and their name/relation) I can contact in case I can't reach you. I recommend at least 2 contacts.

More Information

Most of this section is optional, it just helps me with what your child likes to do, and if they have any responsibilities that need to be fulfilled.

How many children do you have?*

What are their name(s), birthday(s) [mm-dd-yyyy], and preferred gender(s)? *

I kindly request your child(ren)'s name(s), birthday(s) (mm-dd-yyyy), and preferred gender(s) to ensure can provide personalized and attentive care. Knowing this information allows me to celebrate birthdays and plan age-appropriate activities, and address your child's needs effectively. Additionally, understanding your child's preferred gender helps me create a supportive and inclusive environment where every child feels valued and respected. In case of a life-threatening emergency, having the date of birth of a minor is crucial and can expedite the treatment/documentation process.

House & Rules

What types of music (artists or specific songs) do your kids like?

I create separate playlists for different families on Spotify so when I drive the kids, we'll listen to what they enjoy listening to! I might also put in some songs that are similar to their tastes that they might like :) I can share a collaborative Spotify playlist and you can add songs if you'd like, just mention it in your answer!

Rules on photos of kids (hover for more info)*

No photos, please!Yes photos, send them as you take them!Yes photos, would prefer an automatic album (reduces spam messages)Yes photos, my kids also like photoshoots!Other

Top House Rules

Understanding your family's top house rules is essential for maintaining consistency and providing the best care for your child. Please share your top house rules to ensure that I maintain a consistent and cohesive environment for your child between home and childcare. This enables me to reinforce the values and behaviors that are important to you and your family. No shoes in the house? Pets stay inside? Etc.

Screentime

Restrictions on programming or time?

Only to communicate with our family Limit to emergencies OK if child is sleeping Occasional usage is fine

Answer and take message Let voicemail get it No home phone

Personal cell phone policy

House phone policy

Answer and take messageLet voicemail get itNo home phoneOther

Alarm Code

Meals and Snacks

Breakfast

Example: 8:30 AM

Snack

Example: 10:30 AM

Lunch

Example: 12:30 PM

Snack

Example: 2:30 PM

Dinner

Example: 6:30 PM

Favorite Foods

Foods to avoid (not allergic - only if on diet or personal preference)

If it's an allergy, please put that in section 1! Please provide information on foods to avoid based on d or personal preference. This helps me ensure that your child's dietary needs and preferences are respected and accommodated.

Nap 1

Example: 1:00pm

Nap 2

Example: 4:00pm

Bedtime

Example: 8:00pm

37 Bedtime Routine

In the crib/bed

Child onlyStuffed animal is okOther

Fun & Favorites

Favorite toys games and activities

Understanding your child's favorite toys games and activities is essential for providing an enjoyable a engaging environment Please share your childs favorite toys games and activities to help me create fun and personalized experience for them while they are in my care

What does your family like to do for fun?

Knowing what your family enjoys doing for fun helps me create an enjoyable and enriching experience for your child. Please share your family's favorite activities, hobbies, or outings. This allows me to incorporate familiar and enjoyable elements into your child's time with me.

Understanding your child's strengths allows me to provide personalized and supportive care. Please share any strengths or special skills your child has. This helps me create an environment that fosters

and celebrates their individual talents and abilities.

What strengths do your children have?

Understanding your child's strengths allows me to provide personalized and supportive care. Please share any strengths or special skills your child has. This helps me create an environment that fostersand celebrates their individual talents and abilities.

42.What challenges do your children have, and how should I work with them? Knowing the challenges your child faces allows me to provide the best possible care and support. Please share any challenges your child has, and any strategies or approaches that have proven helpfu This enables me to create an environment that helps your child overcome obstacles and thrive.

What challenges do your children have, and how should I work with them?

Knowing the challenges your child faces allows me to provide the best possible care and support. Please share any challenges your child has, and any strategies or approaches that have proven helpfu This enables me to create an environment that helps your child overcome obstacles and thrive.

Extra Questions:

We're at the home stretch here! Just some general questions regarding my responsibilities.

What do you expect of me?

Will I cook meals? Do housework? Wash clothes? Provide homework help?

Any other information that I should know?

Please use this space to share any additional information that you believe is important for me to know about your child Whether its a special need a particular habit or any other relevant details your input valuable in providing the best care possible

Do you have any questions for me?

Please feel free to ask any questions or share any concerns you may have Open communication is essential for providing the best possible care for your child

Will I be providing child transportation?*

YesNoMaybe

ACKNOWLEDGEMENT *

By typing and signing your name, you assume full responsibility for the completion and accuracy of this form. You further understand that any section not completed will affect the quality of Maxwell Mandell’s work. You also agree to all of the terms, conditions, and policies set on Maxwell Mandell's legal page, which can be found at http://childcare.maxwellmandell.com/legal. By this action, you indicate that you understand and agree to the terms and conditions and understand that they are legally binding.

Your Name (First and Last):*

Signature*