FAMILY REGISTRATION

Household Information

     * denotes required information

First Name*   Last Name*   

Home Address*

City*   State*    Zip*

Home Phone*  Alternate Phone 

Fax Number Email* 

Mom's Occupation Dad's Occupation

Children

Name    Gender*  male  female     Age* 0-6 months6-12 months123456789101112131415161718

Name    Gender*  male  female     Age* 0-6 months6-12 months123456789101112131415161718

Name    Gender*  male  female    Age* 0-6 months6-12 months123456789101112131415161718

Name    Gender*   male  female    Age* 0-6 months6-12 months123456789101112131415161718          

Does any of your children have any special needs or considerations? yes    no

If yes, please explain below.

*Do you have any pets?   yes  no  If yes, what kind?

Job Specifications

Live-inLive-out     Full-timePart-timeTemporary    Start date

   Work Schedule

    Monday:  
    Tuesday:
    Wednesday:
    Thursday:
    Friday: 
    Saturday:
    Sunday: 

Please describe the nanny's duties.

Do you require your nanny to drive?                                           yes  no                 

If yes, will you provide a vehicle for the nanny?                           yes  no              

Do you require a nanny who swims?                                           yes   no

Would you hire a nanny who smokes?                                        yes   no

Please describe any other preferences or qualifications that you require of your nanny.

Compensation Package

(Please see our Fees & Services Page for salary and benefits guidelines)

What salary will you offer your nanny?

Will you deduct taxes from the nanny's paycheck, or will the nanny be responsible for paying her own taxes? 
Yes, we'll take care of the taxes      No, the nanny will be responsible for her own taxes

Will you provide any of the following benefits in addition to vacations and holidays? 

Health Insurance   Dental Insurance  Sick Days

    (For Live-In Nannies)  Would the nanny have her own:

Bedroom?   YesNo      Bathroom?     YesNo       TV?   YesNo        Phone Line? YesNo

Additional Comments:

Before you submit, make sure you provided your telephone number and email address!

Thank you for choosing Not Just Nannies.  
We look forward to assisting you to find a nanny that best suits your needs!