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Our names:
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Our home address:
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Our home telephone number:
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Mom's work and/or cell phone numbers:
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Dad's work and/or cell phone numbers:
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Where we'll be:
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We'll
be at:
Name of
place:___________________________
Phone
Number:___________________________
Location:________________________________
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The time we plan to return home:
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When to contact us:
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If a child has been crying for more than 20 or 30 minutes and you can't figure out what's wrong.
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If a child develops a fever, vomits, or is injured (more than a superficial scrape).
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Anytime a situation develops that you feel you can't handle without help.
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Important
Supplies:
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House key is kept:
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Car key is kept:
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First-aid supplies are kept:
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Medications are
kept (Do NOT give medications unless they are listed below):
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In an emergency, if we can't be reached, here's who to contact:
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Name:
Relationship:
Address:
Telephone:
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Name:
Relationship:
Address:
Telephone:
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Name:
Relationship:
Address:
Telephone:
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Emergency help numbers to call:
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Poison control:
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Police department:
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Fire department:
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Hospital or urgent care:
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Pediatrician's name and number:
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What to do in case of a fire:
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In the case of a small, contained fire (on the stove, for example), the fire extinguisher can be used if you already know how to operate one. Our fire extinguisher is located:
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In the event of a larger fire, gather all the children immediately and usher them out of the house via the nearest door or window.
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Test doors before you open them. Kneel down, reach up as high as you can, and touch the door with the back of your hand--at the knob and around the frame. If there's a fire on the other side, it will feel warm on the knob and around the cracks.
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If the door is warm, try another escape route.
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Exits are located:
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Take the kids and go straight to a neighbor's house--preferably one who is on the "in case of emergency" list--and call 911 from there.
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Call us, or one of the above alternate contacts if we are not reachable.
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Health insurance information you may need:
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Insurance company:
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Group/policy number:
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Policy holder's name:
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Policy holder's identification number:
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Details about our children:
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Name:
Age:
Weight:
Height:
Nap & Bedtimes:
Special Instructions:
_________________________________
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Name:
Age:
Weight:
Height:
Nap & Bedtimes:
Special Instructions:
_________________________________ |
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Name:
Age:
Weight:
Height:
Nap & Bedtimes:
Special Instructions:
_________________________________ |
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Name:
Age:
Weight:
Height:
Nap & Bedtimes:
Special Instructions:
_________________________________ |
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Name:
Age:
Weight:
Height:
Nap & Bedtimes:
Special Instructions:
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House rules and routines:
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Television programs and movies that are acceptable or unacceptable:
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Foods that are acceptable or unacceptable:
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Guidelines for outside play:
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Guidelines for company:
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Bedtime routine:
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Special considerations:
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Our discipline philosophy:
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Never leave children unattended with food.
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Special requests:
Please write down details about your day/night with our children.
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What and when did they eat?
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What time did they nap/go to bed for the night?
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Were they well-behaved?
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Follow general safety rules:
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Avoid giving: raisins, hot dogs, raw carrots, celery, grapes, nuts, hard candy, gum, popcorn, raw pears and apples to children under age four years. For ages four to six years, be sure to peel and cut apples, pears, and carrots.
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Never drink or eat anything hot while holding a baby or young child.
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Never leave a child unattended with food. Make sure any food given to children under age four years is cut into tiny pieces (about the size of a fingertip).
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