Virtual Childcare Inquiry Form | Playtime Event Sitters

Parent Guardian Name*

Please list your first and last name

First Last

Phone*

Email*

Child's Name*

First Last

Child's Age*

Any Special Needs?*

Yes
No

Please list Special Needs*

Please List Child's Interests*

Which Session Type Do You Prefer For Your Child?*

One on One
Group
Both

Add Additional Child?*

Yes
No

Child #2 Name*

First Last

Child #2 Age*

Any Special Needs?*

Yes
No

Please list Special Needs*

Child 2: Please List Their Interests*

Which Session Type Do You Prefer For Child #2?*

One on One
Group
Both

Add Another Child?*

Yes
No

Child #3 Name*

First Last

Child #3 Age*

Any Special Needs?*

Yes
No

Please list Special Needs*

Child 3: Please List Their Interests*

Which Session Type Do You Prefer For Child #3?*

One on One
Group
Both

Do your child(ren) need tutoring or school work help?*

Yes
No

Which subjects do your children need help in?*

Ex: Alisa: Arabic & Math, Matthew: English and Reading.

Please list days and times you prefer virtual childcare*

Ex: Flexible, Mondays: Between 11 am - 3 pm, Saturdays: 4 pm - 5 pm, etc.

Additional Comments

Do you give permission for Playtime Event Sitters to take photos of your children?*

Photos may be posted on our Facebook or Instagram pages and/or advertising materials.

Yes
No

Photo Release

I, the undersigned consent to having my child's(ren) photograph and recording/video taken on behalf of Playtime Event Sitters and published. I understand that the images and recording/video may be used in Playtime Event Sitters' and its photographer's print advertisements, online advertisements, presentations, website and social media platforms. I understand that neither I, nor my children, will receive any compensation for use of images and the images are the property of Playtime Event Sitters.*

Please sign below

Waiver

I, the undersigned (parent or guardian) consent to Playtime Event Sitters’ caregivers to care for my children virtually. I understand that I, or another authorized adult must be in the home when virtual sessions take place. Further, I do release and hold harmless Playtime Event Sitters, its directors, officers, employees, representatives, advertisers, partners, clients, contractors and its successors, for any and all claims, suits or action arising out of an accident whereby my child is injured or suffers any illness regardless of if the injuries are caused by negligence. I authorize in any emergency for Playtime Event Sitters to take what action is necessary to receive medical attention for my children. I further agree to indemnify Playtime Event Sitters, its employees, agents, officers, contractors and directors from any and all expense, cost, claims, judgments or executions which may occur due to any accident or event which gives rise to injury or illness to my children.*

Please sign below

Inquiry form

Virtual Childcare

Photo Release

Waiver