Intake Process

Fill out the intake form to the right to receive an email about services.
A Sensory Sitters’ team member will reach out to you within 24 - 48 hours to confirm a virtual meet & greet date/time.
After the meet & greet, you can book your first respite care hours. Text/email us your dates with a start and end time.
Phone (773) 599- 1279
Email: contact@sensorysitters.com

Guardian first and last name

Additional Guardian first and last name

Parents' email

Home Address

City

Zip Code

Phone

Emergency Contact Information

Please include name, full address, relation, and phone number of emergency contact.

Child/ Children

Please include children names, ages, date of birth, and allergies

Type of service

Occasional

Reoccurring

Night time routine

Please include all infomration neccassary for night time routines (bath, sound machine, warm milk etc.)

Meal prep/ snacks

Tidy up/ cleaning

Please include any cleaning that will need to be completed (washing kids dishes, cleaning toy area after playing). respite care provider can complete light housekeeping tasks for the kids.

Medicine

Parents will adminster medicine for clients. If your child is on a mediciation schedule please notify the provider when they arrive. Providers will not be adminstering medicine.

Behaviors/ Sensory needs

Screen time

Please let us know the amount of screen time (tv or iPad) that is allowed.

Limiations for the house

Please provide spaces/rooms/ activities that are not for the children to use. (No running in the house, limit one scoop of ice cream, etc.)

Additional Information

Date

Signature

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Respite Care Provider Information:

The provider shall arrive promptly, and shall not depart early without specific consent from the caregiver(s).
The provider and the caregiver(s) shall adapt to emergencies and unexpected changes to the schedule as they arise. The location may be changed from time to time by the Parent(s).
Sensory Sitters charges $25 per hour and a one-time $30 intake fee. Caregivers can pay via Venmo, Zelle, or by Invoice (Square). Any hours in excess will be paid at the overtime rate of an additional $15 per hour.
The provider shall devote the whole of their time, attention and ability, while on duty, for the performance of their duties and shall follow all lawful instructions of the Parent(s). The provider agrees to perform the following selected duties as a requirement of employment:
Put the absolute safety of the Kid(s) first before all their responsibilities.
The provider shall have the option of preparing meals for themself from food purchased by the Parent(s).
The provider shall follow the Parent(s) direction and preferences concerning actions that give rise to discipline.
The provider is not allowed to have visitors. The provider shall not have any visitors unless approved by caregivers hours advance notice of visitors.
The provider understands that smoking is not permitted. The provider agrees never to smoke (and to not allow their visitors to smoke) in the workplace or while providing childcare to the Kid(s) even on walks, trips to playground, outside activities or field trips. The provider is not permitted to use, or be under the influence of, alcohol or illegal drugs while the provider is on duty. The provider shall not be under the influence of any substance, even if legal or by prescription, if it impairs their ability to care for the Kids(s).
The provider agrees to maintain valid credentials for providing child care according to state law including but not limited to child CPR and First Aid. The provider will provide proof of credentials at the request of the Parent(s).