Virtual Care Please fill out the request form with as much detail as possible so that we can assist in arranging your services. Online inquiries are monitored during normal business hours only (Monday- Friday 9am- 5pm, Eastern Time). After hours, weekend, holiday, last minute and urgent requests are fielded by phone at (888)407-7822.After normal business hours or for a last minute request call us directly for immediate assistance.I understand* I understand HiddenClient InformationClient Information First Name* Last Name* Phone Number*Email Address* Home Address* City* State*--CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip* Reservation Information How did you hear about us?* Reservation Date* MM slash DD slash YYYY Start Time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM Time Zone* Duration*--30 minutes45 minutes55 minutesOtherLanguage Preference Child's Details Child's Name* Date Of Birth* MM slash DD slash YYYY Grade* Gender*--MaleFemaleAdd second child Add Second Child Child's Name* Date Of Birth* MM slash DD slash YYYY Grade* Gender*--MaleFemaleAdd third child* Add Third Child Child's Name* Date Of Birth* MM slash DD slash YYYY Grade* Gender*--MaleFemaleArea Of Interest* Sing Alongs Arts and Drawing Music Yoga Dance Story Time Language Lessons Homework and Tutoring Virtual Field Trip Meditation Online Games Other Motivational Talks Virtual Parties Please Specify*HiddenName of Hotel* HiddenReservation Location* HiddenHotel Address* HiddenCity* HiddenState*--CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHiddenZip* HiddenHotel Manager Name* HiddenManager Email* HiddenManager Phone*HiddenGuest First Name* HiddenGuest Last Name* HiddenGuest Phone*HiddenGuest Email* Please check yes or no on the following items to let us know if your reservation information has changed since your last reservation. If the following items have not changed please check the box for NO CHANGES. If any of your information has changed since your last reservation, please check UPDATES NEEDED and fill out the required information. HiddenAddress No changes Updates needed Hidden If reservation name is different than client name If reservation is at a different location Full Name For Reservation Phone Number For ReservationLocation Name (if Applicable) Full Address (Where Resevation is Requested) HiddenAre the children siblings?*--N/AYesNoSome of them areHiddenIs your child sick?*--NoColdFeverRunny noseOtherHiddenPlease select pet information*--No petsCatSmall dogLarge dogOtherHiddenLate night needed?*--End before 2amEnd after 2amHiddenEnd time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30HiddenAM/PM* AM PM HiddenReservation informationHiddenI would like to make a 2nd Reservation I would like to make a Second Reservation Reservation date MM slash DD slash YYYY Late night needed?--End before 2amEnd after 2amStart time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM End time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM Reservation informationI would like to make a 3rd Reservation I would like to make a Third Reservation Reservation date MM slash DD slash YYYY Late night needed?--End before 2amEnd after 2amStart time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM End time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM Reservation informationI would like to make a 4th Reservation I would like to make a Fourth Reservation Reservation date MM slash DD slash YYYY Late night needed?--End before 2amEnd after 2amStart time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM End time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM Reservation informationHiddenI would like to make a 5th Reservation I would like to make a Fifth Reservation Reservation date MM slash DD slash YYYY Late night needed?--End before 2amEnd after 2amStart time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30AM/PM* AM PM HiddenEnd time*--12:0012:301:001:302:002:303:003:304:004:305:005:306:006:307:007:308:008:309:009:3010:0010:3011:0011:30HiddenAM/PM* AM PM HiddenReservation informationHiddenNumber of children No changes Updates needed Child's Name* HiddenDate of Birth MM slash DD slash YYYY Please select gender*--MaleFemaleHiddenSpecial needs HiddenAllergies Special Needs* No changes Updates needed What?* Allergies* No changes Updates needed What?* Add Second Child Existing Client Add Second Child HiddenDate of Birth MM slash DD slash YYYY HiddenPlease Select Gender--MaleFemaleHiddenSpecial needs HiddenAllergies Special needs* No changes Updates needed What?* Allergies* No changes Updates needed What?* HiddenAdd Third Child Add Third Child Add Third Child Existing Client Add Third Child Child's Name Date of Birth MM slash DD slash YYYY Please Select Gender--MaleFemaleSpecial needs Allergies Special needs* No changes Updates needed What?* Allergies* No changes Updates needed What?* Add Fourth Child Add Fourth Child Add Fourth Child Existing Client Add Fourth Child Child's Name Date of Birth MM slash DD slash YYYY Please Select Gender--MaleFemaleSpecial needs Allergies Special needs* No changes Updates needed What?* Allergies* No changes Updates needed What?* Add Fifth Child Add Fifth Child Add Fifth Child Existing Client Add Fifth Child Child's Name Date of Birth MM slash DD slash YYYY Please Select Gender--MaleFemaleSpecial needs Allergies Special needs* No changes Updates needed What?* Allergies* No changes Updates needed What?* HiddenPet information No changes Updates needed HiddenPlease select Pet information*--No PetsCatSmall DogLarge DogOtherHiddenSitter PreferencesHiddenGender preference*--No PreferenceFemale SitterMale SitterHiddenDo you need a sitter who swims?*--YesNoHiddenPlease tell us about your ideal sitterAdditional commentsCAPTCHA
