Babysitting Locations including: Cape May, Wildwood, Stone Harbor, Avalon, Sea Isle, Ocean City and Atlantic City New Jersey
South Jersey Shore

Georgia

South Carolina

Pennsylvania

Washington, DC

Maryland

Delaware

Virginia

*Sitters may travel up to 1 hour from any of these locations.

Elderly Companionship Membership Application

*How did you hear about Guardian Angels Sitting Service, LLC?
*Member Type:
*Elderly Member First Name: *Elderly Member Last Name:  
     
 
*Address:        
*City:   *State:   *Zip:
   
*Phone:   Fax:   *Email:
   
 
*Applicant First Name:   *Applicant Last Name:    
     
 
*Relation to Member:
Family      Spouse      Friend      Guardian
 
*Do you have permission to request these services for the member?
Yes      No
 
Address: (If Different From Above)        
City:   State:   Zip:
   
Daytime Phone:   Cell Phone:   Email:
   
 
IF STAYING AT A HOTEL OR RESORT
 
Hotel Name:   Room Number:
     
Concierge:   Date Requested:
     
Last Name Room Is Reserved Under:
   
 
If staying in a rental home, Rental Owner's Name:
   
 
Directions Give From (Parkway/Expressway Exit) or (Rt278/William Hilton Parkway)
*Will our services be needed in your:
Home      Hotel      Vacation Home
*What is the primary language spoken?
*Do you have any pets? Yes or No If Yes, what kind?
Sitter Preferences:
Male      Female      No Preference
Age Range: (16+)
Qualities / Skills / Abilities:
*Day: *Date: (MM/DD/YYYY)  
     
*Start Time: (Include AM or PM)   *End Time: (Include AM or PM)    
     
Day: Date: (MM/DD/YYYY)  
     
Start Time: (Include AM or PM)   End Time: (Include AM or PM)    
     
Day: Date: (MM/DD/YYYY)  
     
Start Time: (Include AM or PM)   End Time: (Include AM or PM)    
     
Day: Date: (MM/DD/YYYY)  
     
Start Time: (Include AM or PM)   End Time: (Include AM or PM)    
     
How can a Guardian Angel Sitter best help this elderly member?
Companionship / Conversation
Local Outings/ Walks Outside
Games / Puzzles  
Light meals (sandwiches/ snacks)
Errands (prescriptions, dry cleaning, movie rentals, post-office)
Grocery Shopping (Up to 10 items)
Doctors Visit
 
MEMBER FAMILY INFORMATION
Please notify agency immediately with any changes to membership information
 
Marital Satus:
S     M     W     D
 
Name of Spouse:   Do the member and their spouse live at the same address?
  Yes     No
 
If you answered no to the question above, please list the Spouses Address:
Address:        
City:   State:   Zip:
   
Phone:   Cell:    
     
 
 
Family Details:
1) First Name: Last Name: Date of Birth:
   
Age:   Gender: (Male or Female)   Phone:
   
Address:        
City:   State:   Zip:
   
 
2) First Name: Last Name: Date of Birth:
   
Age:   Gender: (Male or Female)   Phone:
   
Address:        
City:   State:   Zip:
   
Emergency / Contact Information - (If you are unreachable)
*1. First Name: *Last Name: Relation:
   
*Address: