Family Application for The Nanny Club

Family Name: Address: City, State & Zip: Home Phone: ( ) Cell: ( ) Cell: ( ) Email: What is the best time to reach you by phone? Day: Time: Number of Children: Please provide thier name(s), age(s) and birthdate(s). Notes about your schedule: When do you need a child care provider to start? What pay scale were you thinking? What kind of qualities would you like your child care provider to posess? Have you ever had a nanny or babysitter before? If yes, please list your past experience(s) with a child care provider. If you have had a child care provider in the past, may we contact them? Name: Phone: ( ) Are there any special requirments we should know about your child(ren) with regards to diet, education, development, special needs, etc...? If in need of a nanny, would there be a requirment of traveling with your family? Will your child care provider be required to transport your child(ren) anywhere or run errands? If your child care provider uses his/her own vehicle to do so will you reimburse/pay for gas used? Please let us know if there is anything else we may have left out that you feel is important to know about your family and/or your particular child care needs?