Rochester Family Registration

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Note! We highly recommend filling out this form on a laptop or PC.
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Please start by attaching a photo of your family for your portfolio.* This field is required.
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Parent Name
First Name
Last Name
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If applicable, please list your partners first & last name* This field is required.
First Name
Last Name
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Parent(s) Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number* This field is required.Your information will not be shared.
Area Code
Phone Number
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Parent Email Address* This field is required.
example@example.com
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Parent(s) Occupation/Employers* This field is required.
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Does either parent work from home?* This field is required.Please describe
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What type of help are you seeking?* This field is required.
Part-time Nanny (under 30 hrs/week)
Full-time Nanny (over 30 hrs/week)
Nanny/Household Manager
Temporary Care
Overnight Care
Live-In Nanny
Summer Care
Other
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Some of the Nannies we vet have a child of their own and would like to bring their child to work, is this something you would be interested in? * This field is required.We have found that families benefit from added socialization in our post-COVID world. Other benefits include friendship building, sharing/taking turns skill building, etc.
Yes
Maybe for the right fit
No
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When would you like your Nanny to start?* This field is required.
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Tell us about your children. Please include sex and/or gender, ages, DOB, hobbies/interests, special circumstances (medical, dietary, behaviors, allergies, etc.), school status, and anything else you think is important for us to know.* This field is required.
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Name the people who live in your household, and describe their relationships.* This field is required.
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Do you have pets in your home? What kind? Would you like your Nanny to care for them? If so, describe. * This field is required.
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Do you have any other circumstances in your household that make it unique or that you would like us to know? Examples could be a live-in relative, swimming pool, religious/spiritual beliefs, ranch/farm, bi-lingual, etc.Please explain.
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Are the child's parents currently together or separated? If they are not together, who has custody? Whose house will the Nanny be working at? Is there any other information we should know about your family arrangements in order to keep your children safe (i.e., restraining orders, no contact with parents, split custody, co parenting, etc.)?* This field is required.
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Does any family member smoke in the home?* This field is required.
Yes
No
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Have you ever had a Nanny before? If so, how was your experience? Has your child ever received care from someone other than a parent in the past?* This field is required.
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Do you have a parenting styles or personal beliefs to share with us that you think are important for your Nanny to follow and practice with your children? Please share any books or methods you subscribe to. * This field is required.
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What form of discipline or redirection do you use at home? Please share your expectation for how your Nanny should reinforce rules. * This field is required.
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What are your goals as a parent, and how could a Nanny support these goals? (i.e. my children form better hygiene habits, my child learns to read more fluently, etc.)* This field is required.
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What roles, duties, and activities do you want your Nanny to engage in? How would you like your Nanny to spend their time while on the clock?Examples could include: play outside, arts & crafts, homework help, running errands, school pick up, cooking, cleaning, staying home, newborn help, etc.
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Tell us the work schedule you see for your Nanny. What days of the week, start and end times, total hours. * This field is required.
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Is their flexibility in this schedule? If yes, describe. * This field is required.
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Will the Nanny be needed for additional weekend, evenings, overnights, or overtime? Please Explain. * This field is required.
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How long of a contract would you like your Nanny to have?* This field is required.Examples: Summer, 6-month, 12-month For longer contracts, we recommend starting with 12-months
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Is travel required? If yes, describe.* This field is required.
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What is your hourly pay rate range? This will be based on experience, duties, number of children, etc. If unclear, Agency will help you formulate this range.* This field is required.Please note, the minimum hourly rate for a Nanny with our agency is $17/hour. Minnesota averages range from $19-$25/hour.
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Will the Nanny need to drive while on duty? If yes, will you provide a car, or will the Nanny need to transport the children in their own vehicle?
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Do you expect a provider to care for playmates and/or provide coverage for play dates?
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Rochester Poppins LLC requires open disclosure of any unusual lifestyle patterns that may influence or impact the working relationship between family and Nanny. Is there anything that you would like to disclose prior to a Nanny working in your home? Examples include but are not limited to: marital problems, drug use, emotional/financial/criminal/civil problems with which the family is coping?All responses are kept confidential.
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Have you or any member of your immediate family, or anyone living in your home (including ex-spouses if applicable) been arrested or convicted of any offense other than a minor traffic violation? If so, please explain. This information is confidential and used for the purpose of our Nanny's safety.
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Are there any possible risks to the health and safety of the Nanny inherent in this position? If so, describe.
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Will the family accept responsibility to protect the Nanny from physical, sexual, emotional, or psychological abuse by family members and/or guests?
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Lastly, how did you hear about us?
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