Family last name (Please hit tab after each entry)
State
ZIP code
Mother's name
Home phone
Work phone
Cell phone
Pager
Fax
E-Mail
Employer's name
Employer's address
City
Father's name
Easiest way to contact Mother / Father
Child(ren):
First Child's name
Birth Date
Age
Male
Female
Special interests / comments
Second Child's name
Emergency contact name:
Contact phone number
Relationship
Doctor's information:
Name
Location
Insurance carrier
ID / Policy #
Special information about the child(ren), special needs, concerns, allergies, etc.:
Please list any pets in the home (names / types )
I can provide the following nanny services: A Routine nanny is for a set schedule for a 6 month time period.
A Permanent nanny is for a 1-year contact, live out only, where the family and I set the schedule.
Do you need a nanny for:
Routine Nanny/six month contract Permanent nanny/one year contract Other
Certain goals you would like the nanny to obtain while in your home?
Tasks you would require and expect nanny to do, in addition to child-care: kids laundry cooking for kids child-related shopping child-related errands reading homework assistance other, please list
How often for each of above tasks to be completed?
Start date for scheduling a nanny? Days, Times nanny needed:
Directions to home (please start at a major intersection):
TERMS OF THE CONTRACT:
I understand this contract is not validated until it is signed and received with a deposit of $. The family and I agree to the amount of $per hour and that I will be paid for days off, not including Saturdays and Sundays. The family agrees to pay for the following federal holidays, state holidays, OR no holiday pay. The contract hours will include: Mondays-Fridays, between a.m and p.m. It is agreed by both parties that two weeks vacation is allotted to the nanny with a minimum of two-weeks notice to the family. It is also agreed that Christmas, Thanksgiving, Easter, Independence Day and New Years Day will automatically be days off. It is understood that if the contract is cancelled by the family during the three month period, the deposit is non-refundable. If the contract is cancelled by me before the end of three months, a full refund for the deposit will be given. A three month probationary period is allotted for both parties, however, the deposit will not be refunded during that time if the contract is cancelled by the family.
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