Family Application

Parent Information

Main contact e-mail address: *
Name of mother:
Name of father:
Home address (please include your postal code):
Home phone:
Occupation of mother:
Employer:
Schedule:
Work number:
Cell number:
E-mail:
Occupation of father:
Employer:
Schedule:
Work number:
Cell number:
E-mail:
Preferred contact method:
Best time to reach you:

Your Children


First child
Name:
Gender:	MaleFemale
Birth date:
Details (i.e. Naps, School FT/PT, Interests/Activities):
Second child
Name:
Gender:	MaleFemale
Birth date:
Details:
Third child
Name:
Gender:	MaleFemale
Birth date:
Details:
Fourth child
Name:
Gender:	MaleFemale
Birth date:
Details:
Do any of your children have special requirements in terms of behavioural, social, dietary or medical issues? Please provide details:

Household Information


Number of adults (incl. children over 18) residing with you:
Please list your pets (if any):
Do you have any other hired domestic help?
Square footage of home:
Number of bedrooms:
Number of bathrooms:
Are you within walking distance (2 km) of Public Transportation?	YesNo
Caregiver accomodation:	Private bedroomPrivate bathroom Private entrance PhoneTVDVD player Access to computerAccess to vehicle

Caregiver Requirements


Non-smoker:	YesNo
Valid drivers license:	YesNo
Swimmer:	YesNo
When do you need your Caregiver to start?
Caregiver schedule:
In addition to childcare, the Caregiver will be expected to:	Perform light housekeeping Perform full housekeeping Do family laundry Run errands Prepare meals for the family Prepare meals for the children only Drive children to/from school Work weekends/evenings (O.T.) Travel with family
Please list any important attributes/qualifications that you require your Caregiver to have:
Any other important information about your family?

A confirmation will be sent to your main contact e-mail address. We thank you for applying at the Nanny Connection!

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