Parent Registration Form

This form has been designed to give you, as well as our Agency, a better understanding of your situation and the type of caregiver your family needs. Please answer the questions carefully and communicate anything additional to us at info@nannypoppins.com or over the phone. You can reach our agency by calling 617-697-0052.

To Begin the search for your nanny, this form must be submitted along with the Family/Agency agreement.

A $200 Non-refundable registration fee for new clients. (see the fee schedule for more details.)

$100. Non-refundable registration is due fee for repeat clients. We accept Visa and MasterCard via paypal and can send you an invoice. You may also send a check in the mail.

Please remember to fill-out the Family/Agency agreement with this form.

Parent 1
Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Email *

Please do not use an AOL or Roadrunner account.
Employer
Job Title
Work Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Work Phone - (###) - ### ####
Work Fax - (###) - ### ####
Work Email
Parent 2
Name First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Email *

Please do not use an AOL or Roadrunner account.
Employer
Job Title
Work Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Work Phone - (###) - ### ####
Work Fax - (###) - ### ####
Work Email
Children Information
Name and age
Name and age
Name and age
Name and age
Do your child/children have any medical conditions or special siuations that we need to be aware of? If so, explain.
What kinds of activities do you and your child/children enjoy?
Is your child/children involved in extra curricular activities or play groups? If so, please explain.
Caregiver Information
Please describe the days and times that you will needs your caregiver to work each week. Please include any flexibility you may have.
Is this a full time position? Yes No
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?
Have you had a nanny or caregiver in the past? If so, please describe the situation. Was it a positive experience?
What kind of salary would you be willing to pay your caregiver? Please note: Nanny Poppins advises a minimum of $15.00-20.00 per hour. You should also keep in mind specific qualifications and experience.
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? Yes No
Does your family have any pets? If so, what kinds?
Do you want your nanny to do any housework which will not directly relate to the children? If so, what kind? What types of household duties and/or errands do you epect from your caregiver that do relate to the children?
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? Yes No
Will your nanny be required to work any additional hours? Yes No
Will your nanny be required to travel with the family? Yes No
Will your nanny be required to stay at home when you travel? Yes No
Are you ever absent overnight? Yes No
Please explain any situations that we need to be aware of prior to starting our search for your nanny/baby-sitter.
Do you have any particular image in your mind(s) regarding what type of person your nanny 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? Yes No
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 provide two personal references. 1. Name and relation
Phone number - (###) - ### ####
2. Name and relation
Phone number - (###) - ### ####
Please tell us where you heard about Nanny Poppins.

Parent Registration Form

Parent Registration Form

Parent 1

Parent 2

Children Information

Caregiver Information