Resort & Hotel Care Form Parent InformationFor which location you are requesting care?TucsonPhoenixDFWAre you currently an agency Flex Member?*YesNoParent/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:*MaleFemaleAge:*DOB: Date Format: MM slash DD slash YYYY Allergies/Medical Conditions*Child Name 2:Sex:MaleFemaleAge:DOB: Date Format: MM slash DD slash YYYY Allergies/Medical ConditionsChild Name 3:Sex:MaleFemaleAge:DOB: Date Format: MM slash DD slash YYYY Allergies/Medical ConditionsChild Name 4:Sex:MaleFemaleAge:DOB: Date Format: MM slash DD slash YYYY Allergies/Medical ConditionsChild Name 5:Sex:MaleFemaleAge:DOB: Date Format: MM slash DD slash YYYY Allergies/Medical ConditionsCare InstructionsFor 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:* Date Format: 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 InformationBILLING POLICIES: I 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. 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*VisaMastercardDiscoverAmerican ExpressCard Number*Expiration Date*Billing Address*City*State*Zip*Promo CodeCare WaiverCARE 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* Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.