Booking entered by Front Desk Front Desk Clerk Name

Guest's Full Name:

Mother's Name: Father's Name:

Date of Sitting: Time in (am / pm): 6 6:15 6:30 6:45 7 7:15 7:30 7:45 8 8:15 8:30 8:45 9 9:15 9:30 9:45 10 10:15 10:30 10:45 11 12 12:15 12:30 12:45 1 1:15 1:30 1:45 2 2:15 2:30 2:45 3 3:15 3:30 3:45 4 4:15 4:30 4:45 5 5:15 5:30 5:45 am pm

Time out (am / pm): 6 6:15 6:30 6:45 7 7:15 7:30 7:45 8 8:15 8:30 8:45 9 9:15 9:30 9:45 10 10:15 10:30 10:45 11 12 12:15 12:30 12:45 1 1:15 1:30 1:45 2 2:15 2:30 2:45 3 3:15 3:30 3:45 4 4:15 4:30 4:45 5 5:15 5:30 5:45 am pm

Number of children:

Child's / Childrens' name(s):

Child's / Childrens' 1^st language: English Spanish Dutch French Araibic Japanese Chinese Indian Other:

Parent(s') intended location(s) of outing:

Phone:

Phone:

Phone:

I'm requesting:

A babysitter for 3-6 hours 6-12 hours

A Day Nanny Nanny for a week or more

Will you need the sitter to travel with you? yes no

If yes, where and for how long?

Child Information & Prohibitations

1. What and when to feed child / children?
2. How to use any baby equipment (in detail).
3. Allowed t.v. programs: Prohibited t.v. programs:
4. Bedtime (stories/rituals):
5. Medical conditions & procedures:
6. Allergies (details & procedures):

This section must be completed be island residents

Close friends, neighbors or relatives:

Name:

Address:

Phone: Cell:

Family doctor:

Name:

Phone:

Hospital:

Name:

Address: Phone: