Weekly Placement Request Form

1Weekly Placement Request > 2Commitment Form > 3Review Your Entry
How did you hear about Stellar Sitters?
I understand that if a successful placement is made, after the 2 week trial period there will be a placement fee due to Stellar Sitters ranging from $500-$1050 depending upon how many hours/week the sitter works.

I understand that if a successful placement is made, after the 2 week trial period there will be a placement fee due to Stellar Sitters ranging from $500-$1050 depending upon how many hours/week the sitter works. 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 Cat Dog 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
Start Date of Placement Start Date of Placement / MM / DD YYYY
End Date of Placement (most of our sitters are only able to initially commit to 4 months with potential for continuation. Sometimes we do have candidates who can commit to longer than 4 months so feel free to put your ideal end date and we'll give it a try!) End Date of Placement (most of our sitters are only able to initially commit to 4 months with potential for continuation. Sometimes we do have candidates who can commit to longer than 4 months so feel free to put your ideal end date and we'll give it a try!) / MM / DD YYYY
Please list the consistent days/times you need a sitter each week. If you are flexible, please indicate.
What duties/responsibilities would be required of the sitter?
Are you willing to use more than one sitter in the case that there is not one sitter who is available during all of the requested times?

Are you willing to use more than one sitter in the case that there is not one sitter who is available during all of the requested times? Yes No
Additional Information you would like to share.