Family looking for Nanny Registration Form

Clients Full Names Professions Address Including Post Code
Home Number Mobile Number Work Number (If Applicable)
How did you hear about our Agency? Email
Children’s Names and Ages (Please state age next to name of each child) Special Requirements:- Allergies / Needs / Diet / Health etc.)
Nanny Responsibilities – please include if Live in or Out, Temporary or Permanent, Overnight stays will be required – if the position is for sole care of the children or shared – please give answers in detail. This information will also be used for advertising your position – please include as much information as possible:-ie if residential please state if they will be provided with own room / living area etc.
Hours of work per week Do you have any pets – if so what type Languages preferred – other than English – if so please state which
Additional Babysitting Duties Required Qualifications preferred – if so please state which Does the Nanny need to be a non smoker
Does the Nanny need to drive Is a car provided – if so is this for on & off duty – please state below Are there any Safety / Health Risks in the place of work – If Yes please provide a full description
Is the Nanny Required to travel with the family and / or alone with the child/children If so please state suggestions on which destinations this may be
Days off per week Holiday entitlement for employee per year (Minimum 28 Days Including Bank Holidays) Any Other appropriate information
Client Signature:- Date:-
Client Signature:- Date:-
Agency Signature:- Date:-
 I agree to The Northern Nanny Agency terms and conditions