NannyShare Pre-Registration Form

NannyShare Pre-Registration Form

www.rockandrollnannyshare.com
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address 2

City State / Province

Postal / Zip Code
Child 1 (Date of Birth) *
Child 2 (Date of Birth)
Distance Willing to Travel *

Within 1 mile from my home Within 2-4 miles from my home Within 5-15 miles from my home
Desired Start Date *

As soon as possible Within 2-4 Weeks 1-2 Months 3-4 Months
What is your preferred child group size? *

1 child 2 children 3 children 4 children
I am interested in being a host location *

Yes No
Alternative locations you would be willing to travel to (near work/office, etc)
If you wish to pair yourself with another family, please identify the name of the family below:
Do your children have any specific requirements for care, or any things would you like to share about your family?
Are you willing to undergo a virtual home check (host families only)

Yes No
Child 3 (Date of Birth)
My child has recently been enrolled in a childcare center.

Yes No
Would you prefer to be placed with family nearby or a family with children of a similar age? *

A Family Nearby A Family with Children of Similar Age No Preference
If "Yes", what is the name of that center?
What Stage are you in the Process?

I already have a group of friends/neighbors and we want to be matched with an in-home educator. I need help finding a group
What would you like to share about your family with other NannyShare families? *
What are you looking for in the NannyShare service?
If possible, and due to our current circumstances/ situation I would like my child's daily interactions to include ...

Minimal limitations Going out in public with suggested protection, trying to social distance, seeing small social network group Very strict, no outside interactions
Additional Comments
NannyShare Lead Stage

Pre-Reg Form Complete
Should be Empty: