Babysitting Service Registration

Please complete the below registration form, we will then contact you and arrange for the relevant payment to be made.

If you require immediate cover please call us on 01892 836435

Click here to view our Babysitting Service Terms and Conditions.

* Indicates the mandatory fields.

Your Details
Title*
First Name*
Last Name*
Address 1*
Address 2
Town / Village*
County*
Postcode*
Telephone*
Mobile
Email
Confirm Email

Mother's Occupation
Father's Occupation
Emergency Contact: Neighbour or Relative
Name*
Telephone Numbers*
Relationship to Children*

Children's Names*	D.O.B.*
	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1995 1993
	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1995 1993
	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1995 1993
	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1995 1993
	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1995 1993

Do you have any pets?* Yes No
If so please state which

Do the children have any special requirements? e.g. Strict Religious Practices, Special diet (Vegetarian/Vegan/Kosher), Children with special needs, please detail:

Do the children have any special medical requirements or allergies?


Minimum age of babysitter

Specific qualifications
Smoking preferences Don't mind Smoker Non smoker
Hourly rate offered

How frequently do you anticipate you will use our baby sitting service?
(Please ignore if this is a one off sit) Weekly Fortnightly Monthly Occasionally

Any other information?


How did you hear about Elizabeth Henry Nannies?* Other Internet search Yellow Pages Grapevine Recommendation

I wish to register
One off sit (as agreed) Quarterly Half yearly Annually

I confirm that the information I have supplied is accurate to the best of my knowledge and I have read, understood and agree to abide by Elizabeth Henry Nannies Babysitting Terms and Conditions.

Tick here to confirm you agree to the above statement I Agree