Family Registration Form for Nanny Placement
Family Information:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
How did you hear about us? If you were referred to us by someone, please tell us who!
*
Number of Children:
*
Children's Ages:
*
Do you need the nanny to drive the children?
*
Yes
No
Sometimes
Any allergies, special needs, or medical conditions?
*
What are your children’s personalities like?
*
What activities do your children enjoy?
*
Nanny Requirements
Preferred start date:
*
Type of position
*
Full Time
Part Time
Live In
Live out
Are you seeking a nanny with any of the following specialties or certifications:
*
Infant experience
CPR/First Aid
Early Childhood Education
Special Needs Experience
Comfortable with pets
Bilingual
Schedule Needed (Days and Hours)
*
If there is flexibility needed with your nanny, please be specific (evenings, weekends, travel, etc). If not, skip:
*
What does a typical day look like? Please be specific on tasks the nanny would be required to do (include any housekeeping work, driving, etc)
*
Household Details:
Any specific parenting philosophies or discipline style (e.g. Montessori, gentle parenting, etc.)?
*
Will a parent be working from home?
*
Yes
No
Do you have any religious, cultural, or dietary preferences that may affect care?
*
Are there any cameras or monitoring systems in the home?
*
Yes
No
Do you have pets? If yes, please describe:
*
Personality Preferences
Describe the personality traits you hope your nanny will have:
*
What qualities or values are most important to you in a caregiver?
*
Are there any deal-breakers or red flags for your family?
*
Compensation
What is your budget for hourly or salaried pay?
*
Are you offering benefits? (PTO, holidays, health stipend, etc.)
*
Any other specifics you'd like us to know, please list them here:
Please list the best days and times you are available for video conference interviews once we match potential candidates for your family
Submit
Should be Empty: