2141 Kingston Court Suite 102 Marietta, GA 30067 | 770-926-0822 | Email: info@psandqsstaffing.com

Parents Back-Up Care Registration

PARENTS BACK-UP CARE REGISTRATION

Back-up care is a necessity for working parents. You know, that awful feeling in the morning when you’re ready for work and your child is sick. To eliminate the stress we provide parents with in-home child care services You must register in advance in order to ensure the appropriate paperwork is in place.

To register you may:

  • fill out the form below and you will be contacted upon receipt
  • download the registration form and fax to us at 770-956-7633


Please give us a call to discuss your child care needs at 770-926-0822.



Your Name (required)

Home Address (including city, state, zip): (required)

Home Phone (required)

Office Phone (required)

Cell Phone (required)

Your Email (required)

Number of children: (required):

Child 1 Name (required)

Child 1 Age (required)

Child 2 Name:

Child 2 Age:

Child 3 Name:

Child 3 Age:

EMERGENCY CONTACT INFORMATION

Emergency Contact Name 1 (required)

Emergency Mobile Phone 1 (required)

Emergency Home Phone 1 (required)

Emergency Contact Name 2 (required)

Emergency Mobile Phone 2 (required)

Emergency Home Phone 2 (required)

Provide doctor name, address and phone #: (required):

Other special instructions/notes:

Security Code:

captcha


Sitters arrive with a copy of their file and a parent / sitter check list to ensure that all instructions and contact information is communicated.


Our goal is to reduce some stress and provide your children with quality care in your home.