Book a Sitter
Enter your details, your child’s needs, and your requested dates/times, then submit for confirmation.
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
*
Call
Text
Email
Child Information
Child's Full Name
*
First Name
Last Name
Child's Age
*
Add Another Child + Age
How Many Children Will Attend?
*
Is This Your Child's First Time at WHealthy?
*
Yes
No
Book Your Sitting Time
Business Hours
Date Needed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Drop-off Time
*
Hour Minutes
AM
PM
AM/PM Option
Pick-up Time
*
Hour Minutes
AM
PM
AM/PM Option
Recurring Care?
*
Yes
No
Days Needed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Tell Us About Your Child
Allergies or dietary restrictions
Accommodations or additional support needed
What helps your child feel comfortable, calm, and successful?
Emergency contact name
*
First Name
Middle Name
Last Name
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized pickup persons
Payment/Eligibility
How will your child's sitting services be covered?
*
I believe my family qualifies for WHealthy-supported services
Private Pay
I'm not sure — please contact me
Household Size
*
Annual Household Income
*
Important Agreements
Agreement: Supervised care
*
I understand that youth may assist with caring for my child under the supervision of WHealthy coaches/staff
Agreement: Service location
*
I understand this service takes place at WHealthy and not in my home
Agreement: Reachability
*
I will remain reachable while my child is in care
Agreement: Pickup time
*
I will pick my child up by the scheduled pickup time
Agreement: Information accuracy
*
I confirm that the information I provided about my child's needs, allergies, and emergency contacts is accurate
Parent/Guardian Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
Submit Request
Should be Empty: