PARENT/GUARDIAN INFORMATION

Surname:

Given name:

Home phone number:

Work phone:

Mobile phone:

Email:

Address: (Please indicate if the child's home address differs)

CHILDREN'S DETAILS

Name/s and Age/s: (eg:Tim 3, Terry 5, etc)

Allergies or medical requirements: (Please type 'none' if none)

Any special considerations: (Please type 'none' if none)

DESCRIPTION OF REQUIREMENT

Do you require a permanent nanny or casual babysitter? Select one Permanent Nanny Casual Babysitter

Start date:

Days and times required:

Duties required: (Please type 'none' if none)

Does the carer require a driver's licence and vehicle? Select one No Licence Vehicle Both

Expected rate of pay (please see schedule of fees for more information)

Additional Information: (Please type 'none' if none)

How did you hear about our agency? Select one Advert Referral Search engine/Website