KCMS Childcare Referral: Babysitter Form
Please complete this form if you are able to provide childcare.

Thank you for helping to provide childcare to our healthcare providers in this time of crisis.
First Name *
Last Name *
Phone Number *
Email Address *
Are you 18 years or older? *
Are you CPR or First Aid certified? *
Required
What has been your experience working with children? *
Required
What age range(s) are you able to care for? *
Required
Are you able to care for children who have special needs? *
Do you speak any languages other than English? If so, please list them below.
Do you have a car or a form of personal transportation? *
Home zip code in Seattle *
Please indicate your availability to provide childcare. Check all that apply. *
Morning: 6AM - 12PM
Afternoon: 12PM - 6PM
Evening: 6PM - 12AM
Overnight: 12AM - 6AM
Unavailable all day
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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