Nanny Intake Form
Nanny Placement Made Simple, Support Made Personal
Parent name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Tell us about your family needs?
Is this the first time you are hiring a nanny?
What is your ideal work schedule? (Days and hours)
What pay rate are you looking to stay within?
5. Are you flexible with this rate for the right candidate? (yes, no, depends for the right fit) please explain.
Are you offering any job benefits?
Paid Time Off (PTO)
Sick leave
Paid Holidays
Other
Are you aware of household employment taxes and overtime pay requirements?
Yes
No
Will the nanny be expected to drive on the job?
Yes
No
Will a car be provided, or should the nanny use their own vehicle?
Provide car
Nanny will use their own
Are you willing to reimburse for mileage, oil changes, and occasional car cleanings?
Yes
No
Open to discussion
Do you have extra car seats, or are you willing to purchase one?
Yes
No
Willing to purchase
Do your children have any special needs or allergies? If so, explain.
Are your children on any daily medications? If so, explain.
Do you have pets? If so, what breed and are they friendly.
Would the nanny be expected to assist with pet care?
Yes
No
Occasionally
Describe your ideal nanny candidate:
What qualities or experience are you looking for in a nanny?
What does your child/ren enjoy doing?
How would you describe your parenting style?
Structured
Laid back
Free-spirited
Needs routine
other- please explain
What are your preferred methods of discipline?
Are you comfortable with the nanny taking your children to events or playdates?
Yes
No
Open to discussion
Are there cameras in your home?
Yes
No
Planning to install
Do you have additional household staff?
Yes
No
If so, who
What child related duties would you like your nanny to perform?
Childcare only
Light housekeeping
Meal prep
Laundry (child's)
Would you like your nanny to help with household tasks beyond childcare?
Yes
No
Open to pay extra
When family visits, do you expect your nanny to continue working?
Yes
No
As needed
Will you offer guaranteed hours or will hours change weekly?
guaranteed hours (preferred option)
Weekly Changes
Would you require the nanny to travel with the family?
Yes
No
Ocassionally
How do you want to handle illnesses (cold/flu/covid)
Would you prefer a vaccinated nanny?
Yes
No
Deal breaker
Will either parent be working from home?
Yes
No
Occasionally
Do you have any questions about our process or the contract?
How soon are you looking to hire? (soon or timeframe)
Are you open to a trial period before fully onboarding your nanny?
Yes
No
Are there any rules or activities that are off-limits for your children?
Are you willing to cover costs for professional development or nanny education?
Yes
No
Open to it
How long do you foresee needing a nanny?
Until School starts
seasonal (summer, holiday breaks)
Travel Nanny
Long-term
Not sure
Not sure, please explain.
Would you like the nanny to take your children to doctor appointments?
Yes
No
Ocassionally
Come with me
Would you like the nanny to help with birthdays or managing the family calendar?
Yes
No
Ocassionally
Any Additional information I may be missing to ask?
Let's personalize your care.
Trusted, high quality care for your family. Please allow 72 hours to review your submission.
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