CLIENT REGISTRATION
Please complete the following form, providing as much detail as possible.
PERSONAL DETAILS
Title
Miss
Ms
Mrs
Mr
Dr
Rev
Prof
Address
First Name
Last Name
Town
Mobile Tel.
County
Home Tel.
Postcode
Work Tel.
Email Address
Mothers Occupation
Fathers Occupation
Children
Child 1
Sex
Male
Female
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Child 2
Sex
Male
Female
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Child 3
Sex
Male
Female
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Child 4
Sex
Male
Female
Age
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Baby Due
--
Jan
Feb
Mar
April
May
June
July
Aug
Sept
Oct
Nov
Dec
--
2008
2009
Add any further information about your children here
CHILDCARE REQUIRED
Daily
Live In
Permanent
Temporary
Full Time
Part Time
If temporary how long?
If part time select days
Mon
Tue
Weds
Thurs
Fri
Sat
Sun
Hours per day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Start date required
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
April
May
June
July
Aug
Sept
Oct
Nov
Dec
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Sole charge
Yes
No
Salary offered (net per week)
Will your employee be required to do any of the following?
Nursery duties only
Cooking
Light Housework
Shopping
Laundry
Will any babysitting be required?
Yes
No
Do you require a car driver?
Yes
No
If yes please select:
Use of your car
Sole use of your car
Nanny's own car
Would you consider employing a nanny with their own child?
Yes
No
Where did you hear about us?
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Terms of Business
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