Ks Babysitting Service

Police _________________________________________

Fire Department _________________________________

Home Address __________________________________

Local Emergency Room

Hospital Name _________________________________

Address _____________________________________

Phone Number _________________________________

Kids Doctor

Name ________________________________________

Phone Number ________________________________

Kids Dentist

Name ________________________________________

Phone Number ________________________________

Health Insurance Information

Insurance Company ____________________________

Policy Number ________________________________

Household Information (Plumber, vet, etc.)

Company Name _______________________________

Owner Name ___________________________________

Phone Number ________________________________

Company Name _______________________________

Owner Name __________________________________

Phone Number ________________________________

Additional Contacts (Neighbors, family, etc.)

Name _________________________________________

Relationship __________________________________

Phone ________________________________________

Cell Phone ____________________________________

Name ________________________________________

Relationship __________________________________

Phone ________________________________________

Cell Phone ____________________________________

Parents Contact Information

Mothers Name _________________________________

Phone Number ________________________________

Cell Phone ____________________________________

Fathers Name _________________________________

Phone Number ________________________________

Cell Phone ____________________________________

Parents Location (restaurant, movie, etc.)

Name ________________________________________

Address _____________________________________

Number ______________________________________

Return Time ___________________________________

Child Information

Name _________________________________________

Date of Birth __________________________________

Weight ________________ Height ________________

Allergies _____________________________________
Medical Conditions _____________________________

______________________________________________

Child Information

Name _________________________________________

Date of Birth __________________________________

Weight _______________ Height _________________

Allergies _____________________________________

Medical Conditions _____________________________

______________________________________________

Child Information

Name _ _______________________________________

Date of Birth __________________________________

Weight _______________ Height _________________

Allergies _____________________________________

Medical Conditions _____________________________

______________________________________________