Consent Form | Kozzi Kids Babysitting

Parent Guardain Full Name: *

First Emergency Contact

Parent/Guardian Relationship to child/children: *

Second Emergency Contact

Second Contact Full Name*

Second Emergency Contact

Second Contact Relationship to child/children*

Second Emergency Contact

Parent/Guardian Contact phone number*

Second contact phone number: *

Accommodation Details:

Childs Name & Age

Consent to outdoor play:

YesNo

What else do we need to know?

Please advise us of any thing we need to know such as allergies, injuries, phobias or special circumstances

CARER CONSENT

By checking this box I confirm I have read the Kozzi Kids Babysitting Terms & Conditions

YES, I have read

By checking this box I give my consent for a Kozzi Kids Angel to care for my children

YES, I consent

MEDICAL CONSENT (only fill out if required)

If medication is required to be administered to your child by our carer whilst you are away, please provide all details below. Medications WILL NOT be given unless this section is filled out and consent box checked.

By checking this box I give my consent for our Kozzi Kids Angel to administer the above mentioned medication.

YES, I consent

Thank you! Your consent form has been received.

Oops! Something went wrong while submitting the form.

""Lorem ipsum dolor sit amet, consecteturadipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magnaaliqua"

name name, xxxxxxxxx

""Lorem ipsum dolor sit amet, consecteturadipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magnaaliqua"

Name Name, xxxxx

""Lorem ipsum dolor sit amet, consecteturadipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magnaaliqua"

Name Name, xxxxxxx

Family Information & Consent Form