This section provides important child care information, including emergency telephone numbers and medical information for each child. Press [Ctrl+F1] for more information.
Times New Roman
Arial
Child Care Instructions
CCINFO
The Child Care Instructions document provides important phone numbers, medical information, and special instructions to babysitters, day care providers, and other child care providers who will have responsbility for child care on a short-term basis.
! Opening Section (1 of 1)
CHILD CARE INSTRUCTIONS
Date: !
Birthdate: ! Age: !
Birthdate: ! Age: !
Birthdate: ! Age: !
Birthdate: ! Age: !
Birthdate: ! Age: !
! PARENT(S) OR OTHER CONTACT PERSON
! Parent:
Name: !
! Country: !
! Home Phone: ! Ext. !
Hours: !
! Work Phone: ! Ext. !
Hours: !
! Parent:
Name: !
! Country: !
! Home Phone: ! Ext. !
Hours: !
! Work Phone: ! Ext. !
Hours: !
! Other Contact Person:
Name: !
! Country: !
! Home Phone: ! Ext. !
Hours: !
! Work Phone: ! Ext. !
Hours: !
! Relation: !
! LOCATION OF PHONES
! EMERGENCY TELEPHONE NUMBERS
Police: 911 or !
Fire: 911 or !
Ambulance: 911 or !
! Poison Information: !
! Family Doctor:
Name: Dr. !
Phone number during office hours: !
! Phone number after office hours: !
! Address:
! Hospital: !
Name: !
! Address:
! Health Insurance:
Name of Insurance: !
Policy Number: !
Phone: !
! !: !
! !: !
! !: !
! !: !
! MEDICAL INFORMATION
! Special Conditions:
! Medications:
! Allergies:
! First Aid Supplies:
! SPECIAL INSTRUCTIONS
! Bedtime Routine:
! Other Instructions:
! MISCELLANEOUS
Using the format MM/DD/YYYY, enter today's date or edit the information as desired. This date will be used by the program to calculate the age of the Child(ren) by subtracting the birthdate of the Child(ren) from this date.
Enter the name of the first Child or use the P.I. Manager to select and paste a record.
Using the format MM/DD/YYYY, enter the date of birth of the Child or edit the information as desired.
The program calculates the age of the Child, based on the "Birthdate" and the "Date" shown above. You may change the "Age" of the Child only by changing the "Birthdate" or the "Date".
Enter an X to include the name of an additional child.
Enter the name of the Child or use the P.I. Manager to select and paste a record.
Enter an X to include the names and phone numbers of one or both of the Parents and/or the name and phone numbers of an alternate contact person, such as a friend or relative.
Enter an X to include the name of a parent.
The program assumes that you are the Parent and completes the name. Edit the information as desired. Use the P.I. Manager to select and paste a record.
Enter an X to include the Parent's address.
Enter the Parent's street address or edit the information as desired.
Enter the Parent's extended street address or edit the information as desired.
Enter the Parent's city or edit the information as desired.
Enter the Parent's state/province or edit the information as desired.
Enter the Parent's zip/postal code or edit the information as desired.
Enter an X to include the Parent's country, if outside the United States.
Enter the country or edit the information as desired.
Enter an X to include a phone number at which the Parent may be reached during non-business hours.
Enter a phone number, including the area code, at which the Parent may be reached during non-business hours or edit the information as desired.
Enter the phone extension, if needed.
Enter the hours during which the Parent may be reached at this phone number.
Enter an X to include a phone number at which the Parent may be reached during business hours.
Enter a phone number, including the area code, at which the Parent may be reached during business hours or edit the information as desired.
Enter an X to include the name of a second parent.
Enter the name of the Second Parent. Use the P.I. Manager to select and paste a record.
Enter an X to include the name of another contact person.
Enter the name of the Contact Person. Use the P.I. Manager to select and paste a record.
Enter an X to include the Contact Person's address.
Enter the Contact Person's street address or edit the information as desired.
Enter the Contact Person's extended street address or edit the information as desired.
Enter the Contact Person's city or edit the information as desired.
Enter the Contact Person's state/province or edit the information as desired.
Enter the Contact Person's zip/postal code or edit the information as desired.
Enter an X to include the Contact Person's country, if outside the United States.
Enter an X to include a phone number at which the Contact Person may be reached during non-business hours.
Enter a phone number, including the area code, at which the Contact Person may be reached during non-business hours or edit the information as desired.
Enter the hours during which the Contact Person may be reached at this phone number.
Enter an X to include a phone number at which the Contact Person may be reached during business hours.
Enter a phone number, including area the code, at which the Contact Person may be reached during business hours or edit the information as desired.
Enter an X to include the Contact Person's relationship to the Child(ren).
Enter the Contact Person's relationship to the Child(ren).
Enter an X to include a listing of the location of telephones in the Child(ren)'s home. This is helpful information for situations in which the Child(ren) is/are being cared for in their own home by someone, such as a babysitter, who is not familiar with the layout of the house.
Enter the locations and phone numbers of all telephones in the Child(ren)'s home. You may want to include any special instructions regarding the use of the phones (such as using speed dial buttons). You may also want to list the location of the answering machine and any important instructions for using it.
Enter an X to list emergency telephone numbers. For example, the doctor, poison control, police, etc.
Enter the local police department's phone number, including the area code. 911 should only be dialed in emergency situations.
Enter the local fire department's phone number, including the area code.
Enter the local ambulance service's phone number, including the area code.
Enter an X to include the poison information phone number.
Enter the nearest poison control center's phone number, including the area code.
Enter an X to include the name and phone number of a medical doctor.
Enter the name of the Doctor (for example, "Evelyn Jones" or "Wm. Johnson").
Enter a phone number, including the area code, at which the Doctor may be reached.
Enter an X to include a second phone number at which the Doctor may be reached.
Enter a second phone number, including the area code, at which the Doctor may be reached.
Enter an X to include the name and street address of the office where the Doctor is located.
Enter the name of the office where the Doctor is located.
Enter the office's street address or use the P.I. Manager to select and paste a record.
Enter the office's extended street address or edit the information as desired.
Enter the office's city or edit the information as desired.
Enter the office's state/province or edit the information as desired.
Enter the office's zip/postal code or edit the information as desired.
Enter an X to include the name and phone number of a local hospital.
Enter the local hospital's phone number, including the area code.
Enter the name of the Hospital or use the P.I. Manager to select and paste a record.
Enter an X to include the street address of the Hospital.
Enter the Hospital's street address or edit the information as desired.
Enter the Hospital's extended street address or edit the information as desired.
Enter the Hospital's city or edit the information as desired.
Enter the Hospital's state/province or edit the information as desired.
Enter the Hospital's zip/postal code or edit the information as desired.
Enter an X to include health insurance information.
Enter the name of the Insurance Company that provides coverage for the Child(ren).
Enter the policy number of the health plan.
Enter the phone number, including the area code, at which a representative may be reached for pre-authorization or questions regarding coverage.
Enter an X to include an additional emergency name and phone number.
Enter the name of an additional person or organization (e.g., a pastor or church) that should be contacted in an emergency.
Enter the phone number of the additional person or organization.
Enter an X to include medical information about the Child(ren).
Enter an X to include special conditions or circumstances about the Child(ren) that might be helpful or necessary for the Caretaker(s) to know.
Enter any special conditions or circumstances about the Child(ren) that might be helpful or necessary for the Caretaker(s) to know.
Enter an X to include medications that the Child(ren) may be taking.
Enter any medications that the Child(ren) may be taking.
Enter an X to include information about any allergies that the Child(ren) may have.
Enter the information about any allergies that the Child(ren) may have.
Enter an X to include the location of first aid supplies.
Enter the location of first aid supplies.
Enter an X to include any special instructions regarding the care of the Child(ren).
Enter an X to include specific instructions regarding the bedtime routine of the Child(ren).
Enter the bedtime routine of the Child(ren).
Enter an X to include other specific instructions regarding the care of the Child(ren). For example, any special dietary considerations, distribution of household chores, homework rules, television and videotape viewing guidelines, etc.
Enter any other specific instructions regarding the care of the Child(ren).
Enter an X to include any miscellaneous information that might be helpful or necessary for the caretaker to know. For example, if this form is being generated as a babysitting aid, you may wish to include the name and phone number of the restaurant, theater, etc., where you can be reached.
Enter any miscellaneous information that might be helpful or necessary for the caretaker to know.
(.txt)