Fillable Form 5: BABYSITTER / CHILD CARE INFORMATION ad (Monroe-Woodbury Central School District)

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Form 5: BABYSITTER / CHILD CARE INFORMATION ad (Monroe-Woodbury Central School District)

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Babysitter Form 2015DL
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ION DEPARTMENT
. 845-460-6010 : 845-460-6040
: dleviseu@mw.k12.ny.us
BABYSITTER / CHILD CARE INFORMATION
NOTE: This form must be completed every year, if your child requires transportation arrangements
to/from babysitter/childcare.
Pupil Name: _________________________________________________
School Year: _ Grade: __ ________________
Home Address: _________________________________________________
Town: _________________________________________________
Babysitter Name: _________________________________________________
Address: _________________________________________________
Town: _________________________________________________
Babysitter Phone: _________________________________________________
AM Pick-Up: ___ Home
___ Babysitter
PM Drop-Off (Same Location 5 Days per Week): ___ Home
___ Babysitter
Date special transportation arrangements are to begin (if other than the 1
st
day of school):
___________________________________
Is there other information about your child that we should know for safe transportation?
Signature (Parent / Guardian): ________________________________________________
email: ______________________________________________ Date: ______________
Pupil
Babysitter
_________ to __________
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Form 5: BABYSITTER CHILD CARE INFORMATION ad (Monroe-Woodbury Central School District)

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Completed 23 December 2020

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