Client Registration Form 2

Client Registration Form 2

We would love to learn more about your family! Feel free to provide as much or as little information as you prefer. After you submit the form, a staff member will be in touch with you via the primary email address you provide. Thank you!
We don't recruit for:
- split-shift jobs
- nanny positions that require a very inconsistent schedule
- summer jobs transitioning into after-school jobs
- after-school nannies.
Your information will never be bought or sold.

A non-refundable $200 Registration Fee will be requested via PayPal at the end of this registration. If unused, it will be credited toward your balance or made available for 365 days from today.
First Name*
Last Name*
Client E-mail*
Client Address*

Street Address

Street Address Line 2

CityState

Zip Code
Client/Guardian Cell Phone Number*

Area CodePhone Number
Name of Additional Guardian/Client
Additional Client/Guardian Cell Phone Number

Area CodePhone Number
Additional E-mail
How Did You Hear About Us?*

About the Children

Please provide the following information about the children who will require a babysitter or nanny.
Please Mark Any of the Following if It Applies to Your Child(ren):

InfantSpecial NeedsTwinsMultiples
Approximately When Do You Need the Nanny to Start?*
* there is an additional fee for last minute placements
Name of Child One*
Birthday of Child One*
Name of Child Two
Birthday of Child Two
Name of Child Three
Birthday of Child Three
Name of Child Four
Birthday of Child Four

About Your Needs
Level of Cleaning Desired
Level of Cooking Desired
Is there any additional essential information you would like to provide now?
Please Read

This is a baseline of information to get us started finding the best nanny for you. Further information can be provided during our meeting.

To begin with our elite agency, a non-refundable $200 Registration Fee will be requested via PayPal. It will be credited toward your balance or made available for 365 days from today if unused.
Marketing Permissions*

EmailText/SMSCustomized Online Advertising
Client Registration

prevnext( X )
USDDescription

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.