Client Registration Form 2

Client Registration Form 2

We would love to learn more about your family! Feel free to provide as much or as little information as you prefer. After you submit the form, a staff member will be in touch with you via the primary email address you provide. Thank you!
We don't recruit for:
- split-shift jobs
- nanny positions that require a very inconsistent schedule
- summer jobs transitioning into after-school jobs
- after-school nannies.
Your information will never be bought or sold.

A non-refundable $200 Registration Fee will be requested via Square/PayPal at the end of this registration. If unused, it will be credited toward your balance or made available for 365 days from today.
First Name
Last Name
Client E-mail
Client Address

Street Address

Street Address Line 2

CityState

Zip Code
Client/Guardian Cell Phone Number

Area CodePhone Number
Name of Additional Guardian/Client
Additional Client/Guardian Cell Phone Number

Area CodePhone Number
Additional E-mail
How Did You Hear About Us?

About the Children

Please provide the following information about the children who will require a babysitter or nanny.
Please Mark Any of the Following if It Applies to Your Child(ren):
Approximately When Do You Need the Nanny to Start?
* there is an additional fee for last minute placements
Name of Child One
Birthday of Child One
Name of Child Two
Birthday of Child Two
Name of Child Three
Birthday of Child Three

About Your Needs
Level of Cleaning Desired
Level of Cooking Desired
Is there any additional essential information you would like to provide now?
Marketing Permissions
Please Read

This is baseline information to help us find the best nanny for you. You can provide more information during our meeting.

To begin with, our elite agency will request a non-refundable $200 Registration Fee via PayPal. We will credit it toward your balance or, if unused, make it available for 365 days from today. PayPal has applied a $7 transaction fee.
Payment Amount

prevnext( X )
USD$207.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: