Child Care Instruction Form

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2/20 EXAMPLES

Text in this Example:

Child's Name
Age
Bed Time
Meals/Snacks
Time
Activities
Medication
Time / Dose
Allergies
Prohibited Activities For Children
Rules for Sitter
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