For any service inquiries, please call: _______________ (
your cell number, restaurant number or number of your friend's house where you'll be spending the evening)
EmergenciesIn the event that emergency reinforcements are required, please call:
- Fire Hall: _______________
- Police: _________________
- Doctor:_________________
- Hospital:________________
In the unlikely event of an emergency, you can exit the property via:
- Doors: ________________________________________ (describe locations such as front porch, basement walkout, patio doors off kitchen)
- Windows: ______________________________________(indicate whether all windows open or not)
You can also find our fire extinguisher in ________________, first aid kit in ___________, circuit breaker in _________________, main water shut off in ____________________, and a flashlight in _________________.
Medical Details:__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(
You can use this section to list any medical conditions or medications your child might be taking. This is also a good place to let the sitter know if baby is teething, uses gripe water, needs a humidifier for bedtime, tends to spit up food, has diaper rash etc.).
Food and Drink:__________________________________________________________________
__________________________________________________________________
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(
You can use this section to detail when baby is expected to be given a bottle or eat, including proper handling instructions for heating and storing breast milk, if your sitter might be unfamiliar, and what foods should be given. It is also a good place to cite any known allergies and common allergens such as strawberries and nuts, and common choking hazards (popcorn, marshmallows etc.).
Please fill out the following:
Meal: ________________
Time Consumed:________________
What He Ate:_________________________________________________
How He Ate (circle one): well fair not so great
Diaper Changes:
Diaper supplies can be found in ____________________________________________
(
list locations such as changing table and playroom). We normally change our baby's diaper every ______ hours and _________ after a heavy soiling. When changing a diaper we use ______
___________________________ (
list items such as Vaseline, wet wipes, Penaten etc.)
Please fill out:
Time Checked Wet Dry
_________ ___ ___
_________ ___ ___
_________ ___ ___
_________ ___ ___
_________ ___ ___
_________ ___ ___
Sleeping and Naps:
__________________________________________________________________
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(
You can use this section to detail sleeping and napping habits such as typical or set bed and nap times, and routines preceding bed time and nap time.) Please fill out:
Went to sleep at: Woke up at:
_________ _________
_________ _________
_________ _________
Activities:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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(
You can use this section to detail any planned activities for the time you'll be away as well as appropriate and enjoyed activities such as tummy time and reading.)