Our Name: ___________________________________________   Address: ____________________________________________________________

Home Phone #: _______________________________     Cell #: _______________________________ Cell #: ________________________________

Children's Names:                                                                     Age:           Children's Names:                                                                      Age: 

___________________________________________________   ______       ____________________________________________________   ______

___________________________________________________   ______       ____________________________________________________   ______

Emergency Information: (Name and/or Number)

Neighbor:____________________________________________________________________________________________    ____________________

Police: _____________________________    Fire/Rescue: ______________________________   Poison Control: ______________________________

Doctor: ________________________________________  ___________   Dentist: __________________________________________   ___________

Special Instructions:
Location of Thermostat:______________________________________________________________________________________________________

Instructions about Pets:_______________________________________________________________________________________________________

Location of Children's food and clothing:_________________________________________________________________________________________

 _________________________________________________________________________________________________________________________

Children's Habits:___________________________________________________________________________________________________________

Bedtime / Naptime:__________________________________________________________________________________________________________

Children Behavior:  Above Average: _____   Average: _____Needs Improvement: _____

Comments:________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________