New Family Registration Form

What type of care needed?*

Long-Term NannyDate Night/Babysitter

How many children need care?*

Name of Parent/Guardian (1)*

First NameLast Name

Name of Parent/Guardian (2)

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cross Streets*

Phone Number Parent/Guardian (1)*

Email of Parent/Guardian (1)*

ex. (name@gmail.com)

Phone Number Parent #2

Email of Parent #2

ex. (name@gmail.com)

Full Name of Child (1)*

Birthdate of Child (1)*

Full Name of Child (2)

Birthdate of Child (2)

Full Name of Child (3)

Birthdate of Child (3)

Full Name of Child (4)

Birthdate of Child (4)

Full Name of Child (5)

Birthdate of Child (5)

How soon do you need care?*

ex. (01/01/24)

Please describe the schedule needed for care. *

Ex. (Mon-Fri 8am-5pm)

Guaranteed Hours*

Ex. 35 -40 hours a week

What hourly rate fits in your families budget?*

Most nannies in Phoenix area make a range of ($20-30/hour).

What other benefits will a nanny or sitter enjoy while working with you? *

Ex.(paid time off, sick days, gas reimbursement for driving, etc.?)

Please describe your ideal nanny or babysitter. *

Ex. (Education level, personality traits, experience, multilingual, etc.)

Do you need the nanny or babysitter to provide transportation for the children?*

Do any of the children have any medical conditions and/or allergies? Please describe in detail below. *

Are there pets in the home? *

Ex. (Cat, dog, fish, etc.)

Tell us a little more about the child's interests. *

Ex. (Do they enjoy arts and crafts, music, dinosaurs, etc.?)

Please tell us a little about your family. *

Ex. (Do you enjoy healthy eating, vacationing, board games, movies, etc.?)

Thank you for trusting us with your childcare needs! How did you hear about us?*

New Family Registration Form

Children Information