I don't provide back-up care. If an ermgency comes up and I am sick or have an appointment that can't be scheduled in the evening, I just have to tell the parents and they figure out a back-up plan. I hate doing it, but sometimes it does happen. I also do not run errands during daycare hours except for occasionally going through the drive-thru bank machine as others have said. I find it challenging enough to run errands with my own kids without adding 4 more!