The Babysitter's Club Intake Form

Basic Contact Information

Name * Required

Phone * Required

Email * Required

Address

Age:

Availability

Do you have access to reliable transportation?

Yes

No

What time of day are you mostly available? (check all that apply)

Mornings

Afternoons

Evenings

Overnights

What days are you typically available? (check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Are you available for

Last minute / On call options?

Occasional / Date night?

Part-time regular care?

Full-day care?

All of the above

Experience and Preferences

What ages of children are you comfortable caring for?

Newborns (0–6 months)

Infants (6–12 months)

Toddlers (1–3 years)

Preschool (3–5 years)

School-age (5–12 years)

Teens (12+ years)

How many years of babysitting or childcare experience do you have?

Please list any relevant certifications (e.g., CPR/First Aid, Babysitting Course, Early Childhood Education):

Attach any relevant certifications:

Are you comfortable with children who have additional medical or developmental needs?

Yes

No

If yes, please describe your experience:

Are you comfortable caring for multiple children at once? ☐ Yes ☐ No

Yes

No

If yes, how many?

Rates

What is your hourly rate?

Do you offer a daily or flat rate? If so, please describe:

Are your rates negotiable based on family needs or number of children?

Yes

No

Safety and References

Are you willing to provide a Vulnerable Sector Police Check if requested?

Yes

No

I already have one completed within the last two years.

Are you currently certified in CPR and First Aid?

Yes

No

Are you comfortable with pets in the household?

Yes

No

Please provide at least TWO references (ideally from families you've babysat for). Name, phone number, and relationship.

Are you comfortable with your photo being shared on QueenCare's website?

Yes

No

if yes, attach photo:

Getting to know you

Write a short blurb about who you are that will allow families to know if you're a good match! Think about the activities you enjoy doing with kids, highlight your qualities, experience, and share what makes you unique. This is your chance to shine!