FRESH CUT FLOWERS 471 Central Ave , Jersey City, NJ 07307 201-459-9240

Babysitter Checklist

Child Information

Last name: _______________ First name:______________ Middle name:_____________

Date of Birth:____/___/_____ Weight: _________________ Health insurance: ___________

Allergies / Special Medications? Yes No
If so, ?__________________________________________________________________
______________________________________________________________________

Address: _____________________ City:_____________ Zip:_________ State: ______

Mother's mobile number:(____)____-______ Father's mobile number:(____)____-______

Close relative to call in an emergency: Name: _______________ Tel:(____)____-______

Foods not allowed: _______________________________________________________
______________________________________________________________________

______________________________________________________________________

Child's dislikes:
Foods?_____________________________________________________

Child's likes:
Books?_____________________________________________________
TV programs?_____________________________________________________
Activities? _____________________________________________________
Foods? _____________________________________________________

Snacks:_____________________________________________________

Naptime:
Morning Nap: ____:____AM Afternoon Nap: ____:____PM

Bedtime: ____:____PM

Emergency Numbers

Fire Department: (____)____-______ Police Department: 911 Local Police: (____)____-______

Poison control: 1-(800)-222-1222

Pediatrician: Name: _______________ Tel:(____)____-______
Address: _____________________ City:_____________ Zip:_________

Hospital: Name: _______________ Tel:(____)____-______
Address: _____________________ City:_____________ Zip:_________