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Our names:
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Our home address:
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Our home telephone number:
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The name, phone number, and
location of where we'll be:
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The time we plan to return
home:
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House key is kept:
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Car key is kept:
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First-aid supplies are kept:
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Medications are kept:
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When to contact us:
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If a child has been crying for
more than 20 or 30 minutes and you can't figure out what's wrong.
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If a child develops a fever,
vomits, or is injured (more than a superficial scrape).
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Anytime a situation develops
that you feel you can't handle without help.
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Mom's work and/or cell phone
numbers:
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Dad's work and/or cell phone
numbers:
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In an emergency, if we can't be
reached, here's who to contact:
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(Input name, relationship,
address, and telephone)
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(Input name, relationship,
address, and telephone)
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(Input name, relationship,
address, and telephone)
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Emergency help numbers to call:
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Poison control:
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Police department:
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Fire department:
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Hospital or urgent care:
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Pediatrician's name and
number:
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What to do in case of a fire:
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In the case of a small,
contained fire (on the stove, for example), the fire extinguisher can be used if you
already know how to operate one. Our fire extinguisher is located:
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In the event of a larger fire,
gather all the children immediately and usher them out of the house via the nearest door
or window.
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Test doors before you open
them. Kneel down, reach up as high as you can, and touch the door with the back of your
hand--at the knob and around the frame. If there's a fire on the other side, it will feel
warm on the knob and around the cracks. |
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If the door is warm, try
another escape route. |
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Exits are located:
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Take the kids and go straight
to a neighbor's house--preferably one who is on the "in case of emergency"
list--and call 911 from there. |
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Call us, or one of the above
alternate contacts if we are not reachable. |
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Health insurance information
you may need:
|
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Insurance company:
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Group/policy number:
|
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Policy holder's name:
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Policy holder's identification
number:
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Details about our children:
|
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(Input child's full name, age,
weight, height, nap and/or bed times, plus special instructions--food allergies, medical
condition(s), names of medication(s) and dosages, special instructions)
|
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(Input child's full name, age,
weight, height, nap and/or bed times, plus special instructions--food allergies, medical
condition(s), names of medication(s) and dosages, special instructions)
|
| |
(Input child's full name, age,
weight, height, nap and/or bed times, plus special instructions--food allergies, medical
condition(s), names of medication(s) and dosages, special instructions)
|
| |
(Input child's full name, age,
weight, height, nap and/or bed times, plus special instructions--food allergies, medical
condition(s), names of medication(s) and dosages, special instructions)
|
| |
(Input child's full name, age,
weight, height, nap and/or bed times, plus special instructions--food allergies, medical
condition(s), names of medication(s) and dosages, special instructions)
|
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House rules and routines:
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Television programs and movies
that are acceptable or unacceptable:
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Foods that are acceptable or
unacceptable:
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Guidelines for outside play:
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Guidelines for company:
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Bedtime routine:
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Special considerations:
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Our discipline philosophy:
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Never leave children
unattended with food.
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Special requests:
Please write down details about your day/night
with our children.
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What and when did they eat?
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What time did they nap/go to
bed for the night?
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Were they well-behaved?
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Follow general safety rules:
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Avoid giving: raisins, hot
dogs, raw carrots, celery, grapes, nuts, hard candy, gum, popcorn, raw pears and apples to
children under age four years. For ages four to six years, be sure to peel and cut apples,
pears, and carrots.
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Never drink or eat anything
hot while holding a baby or young child.
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Never leave a child unattended
with food. Make sure any food given to children under age four years is cut into tiny
pieces (about the size of a fingertip).
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ClubMom Baby Information
Protecting Your Baby From SIDS
