Authorization Form

Please fill out this authorization form 2 days prior to your babysitting reservation.  Once this form, your Reserve a Babysitter and Payment is received then your reservation will be confirmed. If the form is not filled out, your reservation will be cancelled and deposit is non-refundable. 


Thank you for filling out your Authorization Form!

If applicable, the name of person that initiated the reservation
Contact person must be in Grand County during babysitting reservation
Contact person must be in Grand County during babysitting reservation
Babysitter may apply the following ointments*
Special Dietary Needs*
Developmental Needs*
Ex. vision, hearing, speech, dental, hospitalizations, allergies, behavioral
Significant Health Concerns including Allergies*
Current Medications*
Fever Reducer / Pain Reliever may be given*
Babysitter may transport our child(ren) to a medical facility*
or call an ambulance in any situation. It is understood that, if time permits, a conscientious effort will be made to locate me before emergency action is taken.
Babysitter may make surgical decisions for my child should an emergency arise. *
It is understood that a conscientious effort will be made to locate me before emergency action / decision will be taken, but if this is not possible the expenses of emergency medical treatment or care will be accepted / paid by me.
I release our babysitter and Sitter Service of Grand County LLC from any liability *
in any situation regarding the health or injuries of our child(ren) including, but not limited to, known or unknown allergies or reactions to prescriptions or over the counter medications.
Babysitter may take my child(ren) on trips away from our home *
including yet not limited to bike, stroller, scooter, or by foot.
Babysitter may take my child(ren) on trips away from our home*
by public transportation.
My child(ren) may participate in the use of electronic media *
including yet not limited to mobile phones, iPads, movies, and cable television.
Please list media exemptions and / or desired time frame of usage
Ex. my child may not go outside or his Mickey Mouse doll is in "time out"
I release Sitter Service of Grand County LLC and our babysitter from any liability *
for injury to our child(ren) resulting from any accident, regardless of fault, arising from such transportation or activity in or out of our home. I do hereby waive any claim or course of action I might otherwise have against our babysitter or Sitter Service GC in respect to any such accident. I understand that activities and other excursions are part of the child(ren)’s day. I hereby authorize our babysitter or Sitter Service GC to give medical care when away from our home (and in our home) and hereby agree to be responsible for any medical expenses resulting from such transportation or activity.
I hereby agree to respect and abide by the policy stated above and www.sitterservicegc.com. *
I agree to be responsible for and pay all attorney fees, court costs, filing fees, costs of serving a subpoena, collection fees, babysitter and Sitter Service of Grand County LLC loss of income and all other related costs necessary for the babysitter and Sitter Service GC to enforce the policies stated above and www.sitterservicegc.com. I hereby agree to abide by the child care reservation contract in its entirety and that the contract has been explained to our complete satisfaction.
Once this form is submitted, I authorize it to be used for my future babysitting reservations.*
SUBMIT
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Please answer each * question or the Authorization Form will not be submitted. 

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"sent successfully" message appeared.  Please remember to submit Payment and your Reserve a Babysitter request.