Resort & Hotel Child Care Request Form

"*" indicates required fields

Parent Information

For which location are you requesting care?

Are you currently an agency Flex Member?*

Yes

Parent/Guardian 1 First Name:

Parent/Guardian 1 will be the main point of contact. Please include their contact information below.

Parent/Guardian 1 Last Name:

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Phone (mobile):*

Phone (work):*

Phone (home):

Email Address:*

This is the email where we will be sending general correspondence, booking confirmation, etc.

How did you hear about us?*

Children(s) Information:

Child Name 1:*

Sex:*

Male

Female

Age:*

DOB:

MM slash DD slash YYYY

Allergies/Medical Conditions*

Child Name 2:

Sex:

Male

Female

Age:

DOB:

MM slash DD slash YYYY

Allergies/Medical Conditions

Child Name 3:

Sex:

Male

Female

Age:

DOB:

MM slash DD slash YYYY

Allergies/Medical Conditions

Child Name 4:

Sex:

Male

Female

Age:

DOB:

MM slash DD slash YYYY

Allergies/Medical Conditions

Child Name 5:

Sex:

Male

Female

Age:

DOB:

MM slash DD slash YYYY

Allergies/Medical Conditions

Care Instructions

For your convenience, this information will be provided to the sitter prior to the shift.

Emergency Contact Name:*

Please list someone other than child's parent/guardian.

Phone Number:*

Please write any special care instructions for your child(ren):

For example, daily eat/sleep schedules, routines, rules, activities, etc.

Date of FIRST Day of Requested Care:*

MM slash DD slash YYYY

Beginning and Ending Time:*

Please give us beginning AND ending times for your first care request/shift.

Additional Date(s)/Time(s) of Requested Care (if applicable)

Please provide beginning and end times for any additional care requests. If only one day/shift is being requested, leave this question blank. Payment information must be on file before booking. (See below.)

Location Name:*

Please note that we do not provide sitter services in private, residential settings to non-members.

Where would you like the sitter to meet you at the beginning of her shift?*

Please provide specific instructions for the sitter so she can find you. (i.e. lobby, hotel room/number, ballroom name, etc) We recommend meeting your sitter in the lobby.

Please describe the role you would like your sitter to play during your stay. Please also list any specific activities you would like the sitter to do with your children (on or off-site):

Please provide any other information that will help us provide the best care possible for your child(ren):

Families/groups with more than five children should put additional child information here.

Billing Information

BILLING POLICIES: I, Client, acknowledge that in order to schedule and utilize services, I must have a valid card/account on file with the agency and authorize Trusting Connections to charge my card for any and all services rendered including applicable fees. I understand that I will be charged a $25 cancelation fee (per nanny) if I cancel services with less than 24 hours' notice and I will be charged in-full for the services scheduled if I cancel with less than 12 hours' notice. I further acknowledge that I will be charged for the full time that is scheduled even if the sitter is released early for my convenience. I understand and agree that care requests booked with less than 48 hours' notice will result in a $25 urgency fee. I accept that if any service charges, fees or portions thereof are not paid within fourteen (14) days of invoice, Trusting Connections will charge interest on the unpaid amount. Interest will be calculated by multiplying the unpaid balance by the periodic rate of .833% per month (TEN PERCENT [10%] ANNUAL PERCENTAGE RATE). The unpaid balance will bear interest until paid. In the event the account is turned over to an agency or other person or entity for collection, I acknowledge that all fees and interest, including but not limited to attorney’s fees and costs, incurred relating to the collection activity will be added to Client's original balance, become payable to Trusting Connections according to the terms of this Agreement, and Client agrees to pay Trusting Connections all such fees, costs, and interest. Finally, Client agrees to pay Trusting Connections any charge Trusting Connections incurs if Client’s check or other payment is returned or refused for any reason or pay a $25 bounced check fee, whichever is greater. Any schedule changes or cancellations should be directed to the Scheduling Manager. For urgent, after-hours issues, please call 888-622-9559.*

Yes, I accept.

No, I do not accept.

Full Name (as it appears on card):*

Card Type*

Card Number*

Expiration Date*

Billing Address*

City*

State*

Zip*

Promo Code

Care Waiver

CARE WAIVER: I hereby permit Trusting Connections, LLC to provide care to my child and agree, in taking advantage of this child care service, to release and hold harmless Trusting Connections, LLC, its officers, trustees, agents, and employees, from any and all claims, demands, suits, costs and charges, in connections with or arising out of the child care service, including, but not limited to, bodily harm or injury to my child(ren), except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by a Trusting Connections employee. In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the Trusting Connections sitter or person in charge to engage emergency services to provide necessary medical treatment. I further understand that Trusting Connections caregivers do not administer medication or drive children in their care without written permission to do so.*

Yes, I accept.

No, I do not accept.

Printed Name:*

First Last

Signature*

Date*

MM slash DD slash YYYY

CAPTCHA

Resort & Hotel Child Care Request Form

Parent Information

Children(s) Information:

Care Instructions

Billing Information

Care Waiver

questions?

we help families thrive

Locations

Phoenix

Tucson

Dallas-Fort Worth

Trusting Connections is an award-winning household staffing placement agency and sitter service.

Contact

Headquarters

Parent Information

Children(s) Information:

Care Instructions

Billing Information

Care Waiver

questions?

we help families thrive

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Locations

Phoenix

Tucson

Dallas-Fort Worth

Trusting Connections is an award-winning household staffing placement agency and sitter service.

Contact

Headquarters

Social Media