One-Week Placement Request Form

1One-Week Placement Request > 2Commitment Form > 3Review Your Entry
How did you hear about Stellar Sitters?
If a successful placement is made, there will be a $125 placement fee/week.

If a successful placement is made, there will be a $125 placement fee/week. Yes, I understand. No, I have questions.
Parent / Guardian 1 Parent / Guardian 1 First Last
Parent / Guardian 2 Parent / Guardian 2 First Last
Primary Email
Primary Phone Primary Phone - ### - ### ####
Secondary Phone Secondary Phone - ### - ### ####
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
If sitting location is other than home address, please list below. If sitting location is other than home address, please list below.
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Child 1 Child 1 First Last
Sex of Child 1

Sex of Child 1 Male Female
Birth Month and Year of Child 1
Current age of Child 1
Allergies/Medications/Special Needs for Child 1
Child 2 Child 2 First Last
Sex of Child 2

Sex of Child 2 Male Female
Birth Month and Year of Child 2
Current age of Child 2
Allergies/Medications/Special Needs for Child 2
Child 3 Child 3 First Last
Sex of Child 3

Sex of Child 3 Male Female
Birth Month and Year of Child 3
Current age of Child 3
Allergies/Medications/Special Needs for Child 3
Child 4 Child 4 First Last
Sex of Child 4

Sex of Child 4 Male Female
Birth Month and Year of Child 4
Current age of Child 4
Allergies/Medications/Special Needs for Child 4
Child 5 Child 5 First Last
Sex of Child 5

Sex of Child 5 Male Female
Birth Month and Year of Child 5
Current age of Child 5
Allergies/Medications/Special Needs for Child 5
What pets do you have?

What pets do you have? None Dog Cat Other Other
Will a parent be working from home while the sitter is in your home?

Will a parent be working from home while the sitter is in your home? Yes No
If you live a significant distance from where the sitter lives (15+ minutes) are you willing to pay extra for gas/drive time?

If you live a significant distance from where the sitter lives (15+ minutes) are you willing to pay extra for gas/drive time? Yes No
Additional Information you would like to share
Please list the 4-7 consecutive days/dates/times you are in need of a sitter.
If one sitter isn't available for all of the requested days, would you be open to having multiple sitters? We will do our best to fulfill your placement need with the least number of sitters as we understand the importance of consistency.

If one sitter isn't available for all of the requested days, would you be open to having multiple sitters? We will do our best to fulfill your placement need with the least number of sitters as we understand the importance of consistency. Yes No