We

Babysitter checklist
Where well be
_________________________________________
How To Reach Us
___________________________________
_


Kid 1 Kid 2
Snack
TV
video games
Bedtime
Other


Any licensed physician, dentist, or hospital may give necessary emergency medical service to my children,
______________________ and/or _______________________, at the request of the person bearing this form
with note to the allergies, medications and other information listed above.

Signed: _____________________________________________________________________________
(parent/guardian)

Date: ______________________________
* Permission Granted *
Other numbers in case of an emergency

Allergies
Medications
Our Address

A Sprinkle of This . . . . A Dash of That