Babysitter's Information Sheet | Illinois Poison Center 

Babysitter's Information Sheet

May 24, 2018
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 Babysitter’s Information Sheet

 

 

 

 

Child’s first and last name:

 

Date of birth: 

 

Weight:

 

Allergies:

 

Medical conditions : (asthma/seizures/diabetes)

 

Current medications:

 

Insurance/medical record number:

 

The phone number here is:

 

The address here is:

 

I/we will be at:

 

I/we will return at:

 

I/we can be reached at:

 

In an emergency, call (name):

 

Preferred Hospital (name/address):  

 

Veterinarian name/phone number:

 

Physician name/phone number:

 

Hospital name/phone number:

 

Emergency contact name and phone number:

 

FIRE, AMBULANCE, POLICE: 911

 

ILLINOIS POISON CENTER: 1-800-222-1222 

Keywords: contact sheet, babysitter, caregivers, parents, children
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