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

YYYY

Membership Number

Members Name

First Name

Last Name

Email Address

Caretakers Name

First Name

Last Name

Name & Ages of Children

Phone Numbers of Parent

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Signature

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.