Application for Caregivers

To: The RPC Board of Governors

I request permission for (a babysitter, au pair, mother’s helper or nanny) to have the privileges of the Rocky Point Club for the season while caring for our children

Date *
Date
Members Name *
Members Name
Caretakers Name *
Caretakers Name
Phone Numbers of Parent
Cell Phone
Cell Phone
Home Phone
Home Phone
Work Phone
Work Phone
The caregiver assumes all responsibilities for the children in my absence and will follow the rules of the Rocky Point Club. He/she is authorized to act on my behalf in any emergency that may arise.