While You're Out, LLC :: Babysitting Referral Service

NOTE: If you have already filled out this form, you can go here immediately to access our quick Sitter Request Form.

Parents:

Primary Contact

Occupation

Work Phone #

Secondary Contact

Occupation

Work Phone #

Type of home

Home Address

City

State

Zip

Home Phone #

Fax #

Cell Phone/Pager #

Children:

Name

Gender

Age

Birthday

Name

Gender

Age

Birthday

Name

Gender

Age

Birthday

Name

Gender

Age

Birthday

Information:

When is the best time to reach you?

What do you look for in someone who will be caring for your children?
What do you expect from a potential Babysitter?

Do any of your children have special needs?
If so, please describe:

Does anyone else live in the home other than the above listed individuals?
If so, please indicate name, age, and if they will be in the home while the Babysitter would be there:

Does your family have a pet(s)?
If so, please describe:

Will babysitter be responsible for any care of the animal while babysitting?
If so, please describe:

Please indicate any additional comments, concerns, special situations, or needs regarding your child(ren) that you would like While You're Out, LLC and a potential Babysitter to know?

Please list any upcoming dates that you know you will need a Babysitter for:

If needed, would you allow a sitter to bring their own child on a sitting job?

If you are an out of town client, where will you need sitting services? (hotel or other place you will be staying at, please explain).

References:

Please provide two character references that are not related to you:

Name

Phone #

Relationship

Name

Phone #

Relationship

Other:

How did you hear about us:

Signature:

By checking this box, you agree that the information provided here is accurate to the best of your knowledge.

Disclaimer: The babysitters affiliated with While You're Out, LLC are employed solely by the client and are not employees of While You're Out, LLC.