Luxe Nannies Membership Form

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Parent Full Name* This field is required.
First Name
Last Name
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Parent 2 Full Name
First Name
Last Name
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Mailing Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
If you are a hotel guest, please supply your name of Hotel and room#
5
Mobile Phone* This field is required.
Area Code
Phone Number
6
Text MessagesSelect yes or no to select text messages regarding your appointments
YESNO
7
E-mail
example@example.com
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Emergency Contact Information* This field is required.
Full Name
Address
Contact Number
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Full Name
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Address
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Contact Number
Row 0, Column 2
Full Name
Row 1, Column 0
Address
Row 1, Column 1
Contact Number
Row 1, Column 2
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How did you hear about us?* This field is required.
Luxehaus
Family/Friend
Internet
Instagram
Facebook
Yelp
Other (please specify)
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Other
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Child/Childrens Name and DOBemail info@luxehausem.com if you are requesting service for more than 5 children
First Name
Last Name
DOB (MM/DD/YY)
Child 1
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Child 2
Row 1, Column 0
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Child 3
Row 2, Column 0
Row 2, Column 1
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Child 4
Row 3, Column 0
Row 3, Column 1
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Child 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Child 1
Child 2
Child 3
Child 4
Child 5
First Name
Row 0, Column 0
Last Name
Row 0, Column 1
DOB (MM/DD/YY)
Row 0, Column 2
First Name
Row 1, Column 0
Last Name
Row 1, Column 1
DOB (MM/DD/YY)
Row 1, Column 2
First Name
Row 2, Column 0
Last Name
Row 2, Column 1
DOB (MM/DD/YY)
Row 2, Column 2
First Name
Row 3, Column 0
Last Name
Row 3, Column 1
DOB (MM/DD/YY)
Row 3, Column 2
First Name
Row 4, Column 0
Last Name
Row 4, Column 1
DOB (MM/DD/YY)
Row 4, Column 2
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Do any of the children have any medical conditions or special dietary needs we should know about?* This field is required.Give as much detail as possible, type N/A if nothing.
Huge
Large
Normal
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Ok
Ok
14
What type of Nanny service do you require?* This field is required.
On-Call or Date Night
Newborn/Infant Care
Group/Conference Request
Long Term Placement Part-Time (15-20+ hours)
Long Term Placement Full-Time (40+ hours)
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Information about Rates and Fees:

A 4-hour minimum is applicable for all hourly requests.

A 12-hour cancellation policy is in effect for all requests.

A $15 booking fee is applicable for all Hotel requests.

A $50 booking fee is applicable for all Group/Event requests.

Should you need frequent service, please consider our placement services.

All payments to nannies are paid through our booking platform.

Gratuity is not included.
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What date(s) and time (s) would you like service* This field is required.
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Ok
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Duties Required?* This field is required.
just childcare
light tidying up, childcare,
light tidying up, childcare, meal preparation
light tidying up, childcare, meal preparation and other
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Will the Nanny require transportation?* This field is required.Do you need your Luxe Nanny to Pick up or drop-off of child at requested locations? Please specify.
19
Pets?* This field is required.Any animals in the home or space which the nanny should be aware of?
YESNO
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Select Nanny Range* This field is required.Expert 10+ years of professional experience, Advanced 7+ years of professional experience, Experienced 4+ Years of professional experience, Apprentice 1-2 Years of professional experience, Newborn Care Specialist- certified with 5+ years of experience. Rate will be confirmed upon booking enquiry received and is based on availability.
Newborn Care Specialist $30-35 hour
Expert $20-25 hour
Advanced $16-19 hour
Experienced $12-15 hour
Apprentice $11 hour
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Nanny Cam in-home?* This field is required.Ask us about our nanny cam recommendations!
YESNO
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Please tell us anything important we should know about your family.
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Normal
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Ok
Ok
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Upload your I.D.* This field is required.Please upload a clear copy of Parent 1 & Parent 2 (if applicable) Valid I.D.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Terms and Conditions* This field is required.Please read and agree to the below important information
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Payment * This field is required.A valid credit card is required to secure your reservation. Please choose the appropriate membership level. If you are purchasing a monthly or annual membership please save your card on file and authorize recurring charges. Note- if you are a hotel guest you will be asked to verify your stay with arrival and departure information.
prevnext( X )
Monthly Membership
$20.00 for each month
Purchase
Annual Membership
$200.00 one-time payment.
Purchase
Hotel Guest
$15.00 one-time payment.
Purchase
Summer Special- Monthly Membership
$10.00 for each month
Purchase
Summer Special - Annual Membership
$100.00 one-time payment.
Purchase
Credit Card
First Name
Last Name
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