</br></br></br></br></br> Sitter Chart FormΔ NamePhone/MobileEmailHome AddressCity/BoroughWork AddressCity/BoroughI prefer taking jobs near Home Work EitherMaximum acceptable travel time 15 min 20 min 25 min 30 min 35 min 40 min 45 min Other (please explain)Available Days (Please uncheck any days you are generally unavailable for jobs) Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays SundaysAvailable Visit Times (Please check all times you're available for jobs) Early morning 8:00 am - 10:00 am 10:00 am -12:00 pm 12:00 pm - 2:00 pm 2:00 pm - 4:00 pm 4:00 pm - 6:00 pm 6:00 pm - 8:00 pm 8:00 pm - 10:00 pm late night overnightMedicine Administration Skills (click all skills that apply) Insulin/injections Giving oral meds with syringe Giving eye/ear drops Giving pills directly (pill popper, in churu tube, etc.) Giving transdermal meds IV for subcutaneous fluids Giving Inhalation therapy Other (please explain below)Any out of town trips planned for 2026? Yes No Planned Out of Town Trips Leaving Returning Holiday availability (Click all holidays you're able to work; let us know about any changes) Presidents' Day MLK Birthday Memorial Day July 4th Labor Day Thanksgiving ChristmasAre you able to do twice-a-day visits? Yes NoOnce you've completed this form, please submit. We'll be in touch with you shortly. Submit Form
