Stellar Sitters Placement Package Application

1Family Application > 2Commitment Form > 3Review Your Entry
How did you hear about Stellar Sitters?
Please choose a placement package:

Please choose a placement package: 5 placements $149 10 placements $199 20 placements $299 30 placements $399 40 placements $499
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 the home address, please list below. If the sitting will be at the home, no need to complete this section. If sitting location is other than the home address, please list below. If the sitting will be at the home, no need to complete this section.
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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
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
Pets

Pets None Dog Cat Other Other
Additional Information you would like to share