Queen City Newborn Care: Questions for Nanny- Family Form

Parent Name: *

First Name Last Name

Phone Number: *

Area Code Phone Number

E-mail Address: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Job Details

What ages are your children? *

Are there any special needs we should be aware of? *

Are your children in diapers or potty trained/currently potty training? *

Have your children ever had a babysitter before? *

What kind of help are you looking for? Please click all that apply. *

Regular weekend/date night babysitter As needed nighttime babysitter As needed daytime babysitter Overnight or travel babysitter Not sure

Please give a brief description of your family and let us know if you have pets: *

Describe your ideal babysitter. What kind of qualities should she have? *

What hourly rate would you pay your babysitter? Please note our babysitters charge $17-22 per hour on average. *

How did you hear about us? *