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Family Interview Form

Family Information and Emergency Numbers
Family name: Phone number: Address: E-mail address: Nearest cross-street:	Child’s name Age Weight: 1. __________________________________________ 2. __________________________________________ 3. __________________________________________ 4. __________________________________________
Phone number where parent or guardian can be reached: Cellular phone number: Pager number: Neighbor’s name and phone number:	Local emergency phone number: Doctor’s name: Doctor’s phone number: Poison Control Center (PCC): (800) 222-1222

Household Rules and Discipline
What are the household rules? How would you like me to handle misbehavior?
Do the children need to complete any homework or chores? Would you like me to make sure that these are done?

Safety and Play
Would you take me on a tour of your house? I would like to go over the Babysitter’s Safety Inspection Checklist with you.
Does your family have a fire escape plan? If not, can you have one in place before I begin?
Do your children know Stop, Drop and Roll?
Does your house have working smoke alarms?
Should I apply insect repellant or sunscreen lotion to the children when they play outside?
Do you have any pets that I need to care for? Are they friendly to strangers?
May I meet your children and pets before I babysit?
What are your family’s rules for play? What are your children’s favorite play activities?
Are there any play areas or activities that are off-limits or restricted?
How do I work the door and window locks?
Is there a spare house key for me to use?

Basic Care
How do you want me to handle handwashing and brushing and flossing teeth?
What can your children eat and drink? Will I be preparing any simple meals? Do your children have any food allergies?
What are the routines for diapering and using the toilet? Where are the supplies of baby wipes and cleaning materials kept? Where do you want me to put dirty diapers and soiled disposable gloves?
What are the routines for quiet time, bedtime and naps? When is bedtime? Do your children have a favorite bedtime story? Do they like a light on? Do you prefer their door open or closed?
What do you want your children to wear for outdoor play? For naptime? For bedtime?
Where do I put dirty clothing?
Is there any equipment I might be using to take care of the children that you want to show me?
Are there any medical conditions or medications that I should be aware of? If the child is taking medication, where is it kept? Would you please fill out this Parental Consent and Contact Form in case something happens? What do I need to know?
Where is your first aid kit kept?
Where is your disaster supply kit kept?
Are there any special care needs for your children? Tutoring? Music practice? Sports practice? Faith practices?
Are there any special care needs for your pets?
Is there anything else I need to be aware of?

Business Basics
What is the date and beginning and ending time of the job?
Should I answer the phone? If so, how should I answer it?
Are there any rules I should observe in your home? May I use the TV, radio or computer? May I make a short personal call? Am I allowed to do homework? May I fix a snack?
I usually charge $_______ for my hourly rate. Is that okay with you?

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