Childcare or Household Management Request by Healthcare Workers During COVID-19
PLEASE NOTE: Milwaukee CovidSitters is a service meant to help fill gaps caused by the COVID-19 pandemic and is not meant to serve as a primary childcare service.

WHO: We are students at the Medical College of Wisconsin who are looking to help providers in the Milwaukee area who need help managing their household while serving at the frontlines during COVID-19.

WHAT: This form is intended for ALL healthcare workers (Custodial staff, DO, Med Tech, MD, NP, RN, etc.) in Milwaukee looking for help with childcare/babysitting, grocery runs, pharmacy runs to be able to make connections with current medical/health professions students who want to help them, during COVID-19.

WHERE: In or around the Milwaukee area

WHY: We want to support you as best as we can during this important time of community effort! It takes a village! Please direct all questions to

HOW: After you fill this form, We will look at our central database which contains names of students who are able to help with the above-mentioned. We will connect you with a small group of 2-5 health professional students via email, after which you can make plans as your schedules work! Having a central document for both requests and connections will help us minimize confusion and cross talk.

Please note that this service is flexible and might change daily. We will do our best as students to support you! In return, we ask for your timely response to students and to be aware of our own limitations.

PLEASE READ: If you or anyone in your household meets any of the following criteria, we are unable to partner with you at this time and we apologize:

- Experienced a fever in the past 2 weeks
- Experienced shortness of breath in the past 2 weeks
- Traveled to Europe, China, South Korea, Iran, California, New York, etc. in the past 2 weeks
- Had contact with anyone diagnosed with COVID-19
- Are not fully immunized (standard immunizations + current influenza immunization)

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Email address *
Your name *
Your healthcare institution *
Your cell phone number
What sort of help are you looking for? - Please select all that you anticipate needing. *
What is your expected need for childcare over the upcoming weeks? If you have exact dates and times, please include them below. If not, please estimate your need - we know that there's a lot up in the air.
If you requested childcare, could your needs be filled remotely (i.e. via phone calls, skype)?
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If you requested childcare/babysitting, please let us know how many children you have. *
Please use the following area to inform us of each child's name, gender identity, age, school grade, allergies, health conditions, special needs and any other information we would need to care for them safely. If your children have chronic diseases, such as diabetes/asthma, please let us know if they are well managed or not. Please keep in mind that our students are not professional childcare services.
Please tell us about each child's interest and favorite things to do
Please list the name, relation, and phone number of at least one emergency contact for your child. *
Do you have pets in your home? If yes, what are they?
What is your address? We do our best to match you to student volunteers closest to your area. *
Are you able to accept a volunteer of any gender identity? (check for preference)
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Do you need this service immediately or can we take time in reaching out to you?
Parent/Legal Guardian Contract *
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Parent/Legal Guardian Addendum *
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