So that we may acquire a more detailed understanding of your family’s needs, please fill out the form below. We will contact you as soon as possible, at which time a $200.00 nonrefundable Registration Fee will be charged to process your registration. A $100.00 reduced fee will be billed for repeat clients. Parent/Guardian 1 Name Address Phone Email Current Employer Work Address Work Phone Work Email Parent/Guardian 2 Name Address Phone Email Current Employer Work Address Work Phone Work Email Children Child's Name And Age Child's Name And Age Child's Name And Age Child's Name And Age Do your child/children have any medical conditions or special situations that we need to be aware of? If so, please explain. What kinds of activities do you and your child/children enjoy? Is your child/children involved in extracurricular activities or play groups? If so, please explain. Other Information Please describe the days and times that you will needs your caregiver to work each week. Please include any flexibility you may have. What is your ideal start date? Would you like your caregiver to live in your home? If so, what kind of arrangements would you provide? Will you be providing a car for your nanny? If so, what kind? Is there parking available for the Nanny? If so, is it street or private parking? Have you had a nanny or caregiver in the past? If so, please describe the situation. Was it a positive experience? What is your hourly pay scale for qualified candidates? Are you willing to negotiate regarding health insurance? What kind of commitment are you looking for from your caregiver? Do you have any smokers in your family? Does your family have any pets? If so, what kinds? What types of household duites and/or errands do you expect from your caregiver that do relate to the children? Do you want your nanny to do any housework which will not directly relate to the children? If so, what kind? If you answered yes to the last question, do you understand that unless otherwise stated, the primary concern of the caregiver will be the children? Will your nanny be required to work any additional hours? Will your nanny be required to travel with the family? Are you ever absent overnight? Please explain any situations that we need to be aware of prior to starting our search for your nanny/babysitter. Do you have any particular image in your mind(s) regarding what type of person your nanny? You should be including age/background and qualifications? Does your family have any specific situations that will affect your caregiver? If so, please explain. Please list the best days, times and means of our contacting you regarding your search. Will your caregiver be permitted to monitor activities such as swimming? Would you prefer to restrict certain activities for safety reason? Please explain your policy. Describe the type of person you and your family would want most as a nanny. Please tell us where you heard about Nanny Poppins. By submitting this form, I agree to not hire any applicants sent to me by The Nanny Poppins Agency without first paying the appropriate fee to the Agency. I agree to not to contact any applicants that are sent to by/from The Nanny Poppins Agency without first providing the Agency with a signed copy of their Agency Agreement. I agree to contact The Nanny Poppins Agency and request a copy of their Agency Agreement prior to contacting any applicants sent by/from the Agency.