Babysitting Release Form
Parent/Legal Guardian Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Child's Name
First Name
Last Name
Child's Age
Please write down any allergies or medical conditions of your child.
Please indicate any behavior issues of your child that would help us.
Parent/Legal Guardian Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: