Family Application Form

RESCUE NANNY

Last Name

First Name

Cell Phone

Home Phone

E-mail

Spouse Last Name
if applicable

Spouse First Name
if applicable

Spouse Cell phone

Spouse E-mail

Address

Street 1

Street 2

City

Postal Code

Occupation

Spouse Occupation

Requirements

Start Date

Dwelling

Square footage

Number of Rooms
include all rooms

Household Pets

Smoke-Free Home

Desired Services
Please describe the desired schedule, including days of work and hours per day.

Budget
Hourly or monthly

Number of Children

Oldest Child
(Name, gender, age)

Second Child
(Name, gender, age)

Third Child
(Name, gender, age)

Fourth Child
(Name, gender, age)

Expecting a Child

Due Date

Baby Requirements

Feeding‎ Dressing‎ Reading‎ Bathing‎ Tidying‎ Diapers‎ Preparing baby food‎ Stroller Walks‎

Child Requirements

Clean Bedroom‎ Bathing‎ Dressing‎ Meal Preparation‎ At Home Activities‎ Outdoor Activities‎ Reading‎ School Drop Off/Pick up‎

Housekeeping Requirements

Laundry washing‎ Laundry folding‎ Clean kitchen‎ Clean bathrooms‎ Clean children room‎ Clean master bedroom‎ Preparing family meals‎ Preparing children meals‎ Run errands‎ Watering plants‎ Pet care‎

Accompany on Vacation

Drivers License Preferred

Additional Notes
Please describe any specific child or homecare needs