YIHS Holiday Faire Babysitting Pre-Registration
Thanks for choosing YIHS for your childcare needs. Our school and students have a wealth of child care experience and have been the trusted source for safe, engaging, media-free childcare for PRWS and the Midwest Organic and Sustainable Education Service for over a decade. Here are some things you should know to make the night go more smoothly for all:

-----Hours of service are 6pm to 12am. Pickups after 12:15am will be charged $1/minute/child.
-----Rates are $6/hr. for the first child and $3/hr. for each additional child (e.g., $12/hr for 3 children)
-----Rates will be rounded up to the next hour after the first 15 minutes, so if you're looking for maximum value it's better to
pick up at 9:52 rather than 9:19 as you'll be charged the same amount
-----You may want to provide sleeping support materials (e.g., pillow, blanket, sleeping pad, stuffed animal). There will be some mats for children to lie on, and some blankets but the children often prefer the comfort of familiarity, especially when tired.
-----A light snack will be provided. Please make sure to list any allergies below. If your child has food sensitivities or allergies,
please send along a snack that can be provided to them.
-----There will be two adult chaperones present at all times.

Email address *
Parent Name *
Your answer
Parent Phone Contact *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Child #1 Name *
Your answer
Child #1 Age *
Your answer
Child #1 Allergies
Your answer
Child #1 Medications
Please list all medications the child will have taken that day. YIHS will not dispense any medications.
Your answer
Child #1 Bed Time (if any)
Your answer
Child #2 Name
Your answer
Child #2 Age
Your answer
Child #2 Allergies
Your answer
Child #2 Medications
Please list all medications the child will have taken that day. YIHS will not dispense any medications.
Your answer
Child #2 Bed Time (if any)
Your answer
Child #3 Name
Your answer
Child #3 Age
Your answer
Child #3 Allergies
Your answer
Child #3 Medications
Please list all medications the child will have taken that day. YIHS will not dispense any medications.
Your answer
Child #3 Bed Time (if any)
Your answer
Child #4 Name
Your answer
Child #4 Age
Your answer
Child #4 Allergies
Your answer
Child #4 Medications
Please list all medications the child will have taken that day. YIHS will not dispense any medications.
Your answer
Child #4 Medications
Please list all medications the child will have taken that day. YIHS will not dispense any medications.
Your answer
Child #4 Bed Time (if any)
Your answer
Please list the first and last names of all people authorized to pick up your child. *
Your answer
I am leaving my child with the Youth Initiative High School student babysitting fundraiser (YIHS) and hereby release and waive all claim against YIHS, its agents, employees, volunteers, representatives, officers, or directors, from injuries or damages arising from injuries relating to my child or children's participation at the babysitting at YIHS. I further agree to indemnify, save, and hold harmless from any loss, liability, attorney fees, damage, or cost that they (or any of them) may incur out of or related to the babysitting services offered by YIHS, whether YIHS be negligent or otherwise. *
Please type full name as signature
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