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Child's Name Age Bed Time Meals/Snacks Time Activities Medication Time / Dose Allergies 1. 2. 3. 4. 5. 6. Prohibited Activities For Children Rules for Sitter Yes No Comments Sitter may take children outside Sitter may use your car Sitter may use your computer Sitter may have visitors Sitter may take personal phone calls Sitter may eat food in house Other: Child Care Instructions Contact Information Additional Instructions Family Name Home Address Home Phone Number Parents will be at Parents can be reached at Time expected home Additional Contacts Name Phone Notes In Case of Emergency, Dial 911 First