Where's my Nanny - Caring for you family

Registration form for Families

Type of position (Check all that apply)	F/T Live-out	Part Time	After School
	F/T Live-in	Summer

General Information

Mother's Last Name		Mother's First Name
Employer		Occupation
Work Phone		Fax No.
Cell No.		Email

Father's Last Name		Father's First Name
Employer		Occupation
Work Phone		Fax No.
Cell No.		Email

Family Information

Current Address		City, State, Zip Code
Home Phone		Child 1: Name & Age
Child 2: Name & Age		Child 3: Name & Age
Child 4: Name & Age		Any special needs?	Yes No
Current childcare situation?		Do you have any pets?	Yes No
		If yes, What Kind

Nanny Information

Intended start date for your new Nanny
Living accommodations (If live-in)?
How many days per week required?
Which days and what hours do you need the Nanny?
How many total hours per week?
Do you have any preference in background/sex/age?
Will you consider a Nanny with child?		Yes No
Any household chores required?		Yes No
Will you need an investigation run?		Yes No
Will you provide a vehicle?		Yes No
Will you reimburse mileage?	Yes No	If yes, what rate?
Will Nanny be required to travel?	Yes No	Any Overnights?	Yes No

Salary and compensation

Salary amount?
Will you withhold taxes	Yes No
Will you pay for overtime?	Yes No	If yes, what rate?
Will you provide paid holidays?Which		Yes No
Will you provide health insurance or pay a portion toward it?		Yes No
When will Nanny be reviewed?
Will you provide paid vacation? How many days/weeks?		Yes No
Will you provide sick days? how many?		Yes No

Additional Comments or Questions

A Company of Vamos a Canada Inc.