Babysitter Service Insurance Waiver Form

Babysitter Service Insurance Waiver Form
Please complete this form to provide babysitting details, emergency contact information, and acknowledge the service waiver before care begins.
Client and Family Details
Client/Parent/Guardian Full Name
First NameMiddle NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Number of Children Needing Babysitting
Preferred Contact Method
Child Care and Booking Information
Babysitting Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Start Time
Hour Minutes
AM/PM Option
End Time
Hour Minutes
AM/PM Option
Child(ren) Names
Child(ren) Ages
Pickup / Drop-off Instructions
Care Notes and Special Instructions
Babysitting Location
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact and Authorization
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorization to Contact Emergency Contact
I authorize the babysitter to contact the emergency contact if needed
Waiver Acknowledgment and Signature
Signature
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