CONSTANT BABY-SITTER GUEST PASS APPLICATION

MEMBER INFORMATION

Family Name_____________________________         Member # ________________

Address ______________________________________________________________

              ______________________________________________________________

Home Phone # ____________________ Emergency Phone # ____________________
 
 
 

BABY-SITTER INFORMATION

Baby-sitter's name_______________________________________________________

Address _______________________________________________________________

Date of Birth  ____________________  Emergency Phone #______________________
 

The applicant and person chosen as the baby-sitter have read the rules and agreed to observe them,
failure to do so may result in cancellation of the baby-sitter privileges. The applicant agrees to pay
the fee of $75.00 upon approval of this application.
 

_________________________________________
Applicants signature

_________________________________________
Baby-sitter signature

_____________________
Date

Skippack Recreation Association * 1224 Cressman Road * P.O. Box 355 * Skippack, Pennsylvania  19474
 610-489-2499 *  skippackrecreation@verizon.net