Please complete the form below to register your family with Babysitter Express.

By registering with Babysitter Express, you gain access to our childcare professionals for a full year. After you are a registered client, you can reserve a childcare provider for any time you need one!

Maternal Guardian Name *
Maternal Place of Employment
Maternal Work Phone
Maternal Home Phone
Maternal Cell Phone
Paternal Guardian Name *
Paternal Place of Employment
Paternal Work Phone
Paternal Home Phone
Paternal Cell Phone
Primary Street Address *
Preferred Contact Email Address *
How did you hear about Babysitter Express?
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Relationship *
Emergency Contact Alternative Phone
Pediatrician Name *
Pediatrician Office Name
Pediatrician Phone *
Pediatrician Emergency Phone
Preferred Hospitall
Client Membership Level *	Platinum ($99) Gold ($79) Silver ($59)
Promotion Code
Child One Name *
Child One Birthdate *
Child One Allergies *
Child One Preferred Foods
Child One Favorite Toys/Games/Books
Child One Learning Disabilities or Behavior Problems
Child One Routine
Child Two Name
Child Two Birthdate
Child Two Allergies
Child Two Preferred Foods
Child Two Favorite Toys/Books/Games
Child Two Learning Disabilities or Behavior Problems
Child Two Routine
Child Three Name
Child Three Birthdate
Child Three Allergies
Child Three Preferred Foods
Child Three Favorite Toys/Games/Books
Child Three Learning Disabilites or Behavior Problems
Child Three Routine
Child Four Name
Child Four Birthdate
Child Four Allergies
Child Four Preferred Foods
Child Four Favorite Toys/Games/Books
Child Four Learning Disabilities or Behavior Problems
Child Four Routine

Click "Online Client Agreement" To Complete Your Online Registration!
You are not officially a registered client until after submitting your Online Client Agreement form and by submitting the above form!