Your name:

Date:

Home Address:

Local Accomodations (Hotel/Chalet)

Room Number:

Length Of Stay:

Mobile Phone Number:

Dates and Times you require childcare,

Be as detailed as possible!:

Please list the names, genders and ages of the children requiring care:

Do your children speak / understand english? (Yes/No)

If no, what is the primary language:

Do your children have any food allergies; dislikes, or specific care instructions:

Do your children require use of any medications in treatment of chronic illnesses such as epilepsy or asthma? Please explain any illness or issues and medications used.

What type of activities do your children enjoy (including arts and crafts, video and board games, outdoor activities)?

List any other comments or special instructions: