Please enable JavaScript in your browser to complete this form. – Step 1 of 6Babysitting RegistrationFor more information, please email Rawan Amaireh RawanAmaireh25@GMail.comBabysitting Requested For *April 01, 2023Parent Account DetailsFather Name *FirstLastMother Name *FirstLastEmail *NextAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact Name *FirstLastEmergency Contact Phone *PreviousNextBaby DetailsName *FirstLastBaby's Age *— Select one — 2345678GenderFemaleMaleBaby's Doctor's Name (Optional)FirstLastBaby's Doctor's Phone (Optional)Is anyone besides you allowed to pick up your child? *NoYesPlease list who can pick up your child: *PreviousNextPlease let us know about any behavioral concerns (Optional):Please let us know any medical conditions, chronic illnesses, or allergies? *Please list any food allergies *PreviousNextMedical Release and Authorization:A parent or guardian sign below *Yes, I have read and accepted the termsNo, I do not consentI hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of my child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of my child’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for myself and/or my child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to ISCN and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of my child.Signature * Clear Signature PreviousNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit