Babysitting Registration Form – Family Room Chicago

Family Room Babysitting Registration Form_Enrollment Details

Primary Adult First Name

Primary Adult Last Name

Secondary Guardian First Name

Secondary Guardian Last Name

Primary Guardian Contact Email

Secondary Guardian Contact Email

Primary Guardian Contact Phone Number

Secondary Guardian Contact Phone Number

Additional Approved Adult Pickups

Babysitting Location

Child 1 First and Last Name

Child 1 Date of Birth (for accurate age)

Child 1 Health, Medical, Diet

Child 2 First and Last Name

Child 2 Health, Medical, Diet

Child 3 First and Last Name

Child 3 Date of Birth (for accurate age)

Child 3 Health, Medical, Diet

Planned Drop Off Time

Planned Pick Up Time

Anything else we should know to support your family?

I have read and agree to the Terms and Conditions and Privacy Policies.

I agree to Family Room Chicago LLC caring for my child(ren). I agree to Family Room Chicago LLC and staff coordinating care with designated caregivers and medical professionals if needed for immediate / urgent needs. **I agree to notify Family Room Chicago if my child(ren) will be absent/cancelation and that there are no refunds: connect@FamilyRoomChicago.com.