Family Connection Form
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
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What kind of support are you looking for? (Example: part-time nanny, full-time, STEM- focused care, travel help, household planner, etc.)
How old is your child/ children?
Do any of your children have special needs or medical considerations?
What are your children's interests or hobbies?
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Days of the week needed:
M
T
W
TH
F
Sat
Sun
Hours needed per day
1-3
3-6
6+
Other
Start Date
ASAP
1-3 Weeks
1-3 Months
3+ Months
Will you need:
Late nights (past 7PM)
Early Mornings (before 8AM)
Weekend Care
Will you need help during school breaks or holidays?
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Will you need the nanny to drive your children?
Will you provide a vehicle or will nanny need to have her own car?
Will you reimburse for gas/mileage?
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Check if nanny will need to do:
School Pick up/ Drop off
Drive to Extracurriculars
Homework Help
Prepare Meals or Snacks
Bath/ Bedtime Routine
Light Housekeeping
Plan Playdates
Travel with Family
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What is the hourly pay range?
Any benefits or perks of working with your family?
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Minimum years of experience required?
1+
2+
3+
5+
Any dealbreakers or red flags we should avoid?
Submit
Should be Empty: