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 Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
*
Preferred Contact Method:
*
Home Phone
Mobile Phone
Email
Is your mailing address different from your home address?
Yes
No
Is this your first time working with an agency
*
Yes
No
Have you been released from an agency in the past?
*
Yes
No
N/A
How did you hear about us?
Word of Mouth
Search Engine
Online Advertisement
Facebook
Instagram
LinkedIn
NextDoor
Google Reviews
Other
How can we assist you? What services are you most interested in?
*
Long-Term Placements (Full/Part-Time, 1 Year or More)
Temporary Placements (Recurring Monthly – Up to 9 Months)
Commuter Companion (Before School: 6:30–9:00 a.m.)
Commuter Companion (After School: 3:00–6:30 p.m.)
Commuter Companion (Full Day Support: 6:30 a.m.–6:30 p.m.)
Back-Up Care (One-Time Daily Coverage)
Overnight Care
Summer Placement
Church Care Placement
A la Carte Screening Services
How many hours per week do you anticipate needing care?
*
When is the anticipated start date?
*
Share your care schedule, specifying days and times, to help us better meet your family's needs.
Rows
Start Time
End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When is the best time for us to get in touch with you?
How much would you like to pay your caregiver per hour? The minimum starting rate for all positions is $23 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?
*
1
2
3
4
5+
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?
*
Yes
No
Do you own any pets?
*
Yes
No
Would you be open to hiring a male nanny?
*
Yes
No
Is the caregiver required to drive in this position?*
Yes
No
Is there anything else you would like us to know?
Promotion Code:
Are you using a promotional code?*
Submit
Should be Empty: