Babysitting Services- Registration

Out-of-School Babysitting Registration

2025
Please fill out for all children attending.
1st Child's Name:*

First NameLast Name
Gender:*

MaleFemale
Date of Birth:*

MonthDayYear
Date
Type a question*

Out-of-School Care-= February 17, 2025 - $50
2nd Child's Name:
Gender:

MaleFemale
Date of Birth:

MonthDayYear
Date
Type a question

Out-of-School Care-= February 17, 2025 - $50
Parent/Guardian Contact Information:
Mother's Name:
Mother's Email:
Mother's Cell Phone:

Area CodePhone Number
Mother's Business/Work Phone:

Area CodePhone Number
Father's Name:
Father's Email:
Father's Cell Phone:
Father's Business/Work Phone:
Please state any shared custody/custody orders, if applicable:
(Divorced/separated with shared bi-weekly custody)
Child's primary Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do your children have health issues? If so please describe:
Do your children have allergies? If so list here.
Do your children have any physical, social, or emotional challenges we should be aware of? If so describe here:
Two other people to contact in case of emergency if parents cannot be contacted:
First Emergency Contact's Name*

First NameLast Name
Release for Pick ups*

Yes this person can pick upNo this person cannot pick up
Relationship to Child:*
Phone:*

Area CodePhone Number
Second Emergency Contact's Name*

First NameLast Name
Release for Pick ups*

Yes this person can pick upNo this person cannot pick up
Relationship to Child:*
Phone:*

Area CodePhone Number
Please provide any further information relating to your child that would be helpful in understanding and caring for your child:
Payments are DUE UPON REGISTRATION. Bkft, lunch, snack wil be provided.

Babysitting for school-age children when school is closed for students.

$50.00 fee per child for care between 6:30am to 6:00pm. Invoice/payment link will be emailed and must be paid within 36 hours of registration or registration will be cancelled.

Location: 661 Lincoln St. Portsmouth, VA.

50% of the fee is refundable if babysitting services are canceled via email 72 hours before the scheduled day of babysitting. Email careformeyouth@gmail.com to cancel. Nonrefundable if canceled within 72 hours of babysitting service.

Fee-based extended care hours available upon written request.
COVID-19 & FLU Warning & Disclaimer : COVID-19 & FLU is an extremely contagious virus that spreads easily through person-to-person contact. Care For Me Youth Initiatives in no way warrants that COVID-19 or FLU infection will not occur through participation in our programs. The temperature of every child will be taken upon drop-off. All children with a temperature of 99.5F and above will be unable to stay and will remain with the parent/guardian.
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Out-of-School Babysitting Registration

Parent/Guardian Contact Information: