CCC ORANGE COUNTY VOLUNTEER FORM
As a community, we need as many medical professionals as possible working to fight the COVID-19 outbreak. In light of recent school closures across Orange County, many hospital staff (nurses, technicians, medical professionals, etc.) will be forced to choose between going to work and taking care of their children.

The community needs your help to combat the COVID-19 outbreak. Please sign up below if you are willing and able to be a volunteer babysitter!

If you have any questions, concerns, or suggestions, feel free to contact us at oc.covidchildcare@gmail.com or
visit our website www.covid-childcare.org
Full Name: *
Phone number: *
Email: *
Location: (Example: Mission Viejo) *
Availability: (Example: Mondays 6am-9pm, Saturday and Sunday 9am-4pm etc.) *
Age: *
Do you have a valid driver's license and access to a car? *
Current school/occupation: *
Prior childcare/babysitting experience: *
Are you willing to provide other services to medical workers including, but not limited to errands/ grocery runs?
Clear selection
Do you speak any languages besides English?
Age range of children you are comfortable working with: (Example: 4-13) *
Can you babysit at your house?
Are you able to tutor any children grades K-12? If so, what subjects or grade levels?
Have you ever been arrested, charged, or convicted of a crime anywhere in the world? If yes, please provide the date and circumstances. *
Have you ever been investigated by a child protection services agency for concerns of child neglect or abuse? If yes, please explain. *
How did you hear about us? *
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