Client/Family Registration Form

Contact Name*

Family Name

Family Address

Correspondence Name and Address: (if different from above)

Email Address

Home Tel. No.

Work Tel. No.

Mobile No.

Facsimile No.

Preferred Method of Contact

Family's Nationality

Mother's Occupation

Father's Occupation

Please give children names, sex and ages:

Do any of your children have a disability or special need? If so, please explain:

Does your family or any member of it follow any particular diet? If so, please specify:

Does your family have any religious beliefs which they would expect the candidate to observe or be aware of? If so please specify:

Is a new baby expected? If so, when?

What are your families’ interests/hobbies?

Does anyone in the home smoke?

Do you have any pets? If so, please specify:

What type of help is required? Eg: Nurse; Nanny – full time/part time, daily/live in; Mother Help; Other please specify:

Is this a new position?

Do you require specific childcare qualifications and if so what?

Would you prefer a male or female candidate or do you have no preference?

What is the start date of the engagement?

What is the length of the engagement?

Is a driver required?

Is your car a manual or automatic?

Will the car be made available outside of working hours?

What public transport is available?

Would you accept a smoker?

Will the candidate have sole charge of your children?

Please specify the days and hours of work:

Please specify what holidays the candidate will have in addition to the statutory days:

Would the candidate ever be left alone overnight with the children? If so please explain:

What are your babysitting requirements?

Would the candidate be expected to accompany your family on family holidays?

Net weekly salary bracket offered (Depending on experience and age):

Do you have any other staff? If so please specify:

Describe your home (i.e. flat, house, other):

Describe your home’s location (i.e. town, village, country, seaside):

Describe the accommodation the candidate will occupy:

Is there any other information you think may be relevant or useful? If so please explain:

How did you hear about us?

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If you are happy that you have filled in the correct information, click below to submit your form.

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