Family Inquiry Form

Family Inquiry Form

Welcome to Nanny Match! Our team is looking forward to learning more about your family and childcare needs. As this is the first step in our process, we kindly ask that you complete the form in its entirety. After completing the form, a member of our team will contact you to schedule your consultation within the next 24 hours.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Home Phone
Please enter a valid phone number.
Mobile Phone*
Please enter a valid phone number.
Occupation*
Preferred Contact Method:*

Home PhoneMobile PhoneEmail
Is your mailing address different from your home address?

YesNo
Is this your first time working with an agency*

YesNo
Have you been released from an agency in the past?*

YesNoN/A
How did you hear about us?

Word of MouthSearch EngineOnline AdvertisementFacebookInstagramLinkedInNextDoorGoogle ReviewsOther
How can we assist you? What services are you most interested in?*

Long-Term Placements (full-time and part-time nannies)Temporary Placements (Monthly -Up tp 9 Months)Back-Up Care (Daily Bookings)Overnight CareSummer PlacementChurch Care PlacementA la Carte Screening Services
How many hours per week do you anticipate needing care?*
When is the anticipated start date?*
How much would you like to pay your caregiver per hour? Select from below.*

$23-$25$25-$30$30-$35+
Based on your selection, what is the minimum rate you are willing to pay per hour?*
Based on your selection, what is the maximum rate you are willing to pay per hour?*
How many children do you have?*

12345+
How old are they and what are their names?*
What are some activities that you and your family enjoy doing together?*
Would you like your caregiver to perform these same activities with your children?*
Explain briefly what the nanny's responsibilities are in this position.*
Would the caregiver be expected to perform any additional duties outside of childcare?*
During the next year, do you anticipate having more children?*

YesNo
Do you own any pets?*

YesNo
Would you be open to hiring a male nanny?*

YesNo
Is the caregiver required to drive in this position?*

YesNo
Is there anything else you would like us to know?
Promotion Code:
Are you using a promotional code?*
Should be Empty: