Family Application | Custom Form

Parent Name *

Cell Phone: *

Do you work from home? *

Email *

Please list employment title / employer *

Parent 2 Name

Cell Phone 2:

Do you work from home?

Email 2:

Please list employment title / employer

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How did you hear about us? *

Indeed Friend/Family Social Media CARE.com Previous Nanny Internet Other

Family Street Address *

City *

State *

Zip / Postal Code *

Home Phone Number

Job description *

Tell us about what you're looking for.

Your children *

Please tell us about your children that require care.

Child #1

Child's name

Child's gender

Child's age

Describe your child

Please list any additional children that may be in your family: *

If there are no other siblings then enter NONE

We would love a family photo to include with your profile.

Are There Any Smokers In Your Household: *

Type of Pets in the house *

None Dog Cat Bunny Hamster Gerbil

Type of Service(s) Requested *

Length of Experience Requested *

Preferred Hourly Rate *

$16-$18/Hour $19-$21/Hour $22-$24/Hour $25-$28/Hour $29+/Hour

Please list your preferred start date *

Will you Require your Nanny to go on Vacation with you? *

Please Select the desired amount of Child Transportation: *

Is this a Live-In Position? *

If yes, Can you Please Describe Accommodations:

Would you Consider Sharing a Nanny? *

Will Occasional Overnight Stay be Required? *

Would you be Interested in a Nanny with their own Child to Accompany them? *

Number of Nannies Your Family Has Had In The Last 5 Years: *

Previous Child Care References:

Desired Nanny Hours/Times *

Please select one -How long are you looking to have a nanny placed with your family *

1 Year 2-5 years 5-10 years Summer only Date nights

Please list your Families Interests and Activities *

Please Describe an Average Day, Including Household Duties, Which your Nanny Would Encounter: *

Please select all responsibilities you will require your Nanny to perform, aside from child-care: *

Light Housekeeping / General Pick-Up Errands Family Cooking Grocery Shopping Purchase Gifts Ironing Children's Laundry Family Laundry

We will require a flu shot for this position ? *

We will require your nanny to receive the COVID-19 Vaccine for this position ? *

Please select you homes cleanliness level *

Needing Assistance Average Neat & Orderly Meticulous

I approve the information provided in this document to be shared with potential candidates *

I understand there will be a fee for Agency services *

The information provided in this document is accurate to the best of my knowledge. *

Parent 1 Signature Typed

The information provided in this document is accurate to the best of my knowledge.

Parent 2 Signature Typed

After clicking Submit, you'll be directed to our calendar to book a consultation with us. Choose a day and time that's convenient for you. We're looking forward to working with you!