Parents Registration

Please complete the below registration form either providing us with brief details (full details to be provided at a later date for precise requirements) or provide us now with the full details of your childcare needs. We will then contact you by your preferred method to discuss further details and answer any questions you may have.

If you require immediate cover please call us on 01892 836435

Click here to view our Terms of Business and Fee Structure.

* Indicates the mandatory fields.

Your Details
Title*
First Name*
Last Name*
Address 1*
Address 2
Town / Village*
County*
Postcode*
Telephone*
Mobile
Email
Confirm Email
Preffered Method of Contact* Phone Email Post

Childrens Details

	Gender	D.O.B.	School and Nurseries attended
Child 1*	Boy Girl	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
Child 2	Boy Girl	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
Child 3	Boy Girl	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
Child 4	Boy Girl	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
Child 5	Boy Girl	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

Is a new baby expected? Yes No

Expected date of arrival

Requirements
Requirements* Nanny Mothers Help Maternity Nurse Night Nanny
  Nanny / House Keeper After School Care Occasional Care

  Daily Live in Sole Charge Shared Care

  Full Time Part Time Temporary

Start Date Required*
End Date (if applicable)

Days Required* Mon Tue Wed Thu Fri Sat Sun

Hours (approx.) From *
Until

Weekly salary Net
(approx) Gross

Will you be using the childcare vouchers scheme? Yes No
How did you hear about Elizabeth Henry Nannies?* Other Internet search Yellow Pages Grapevine Recommendation

Any further information you would like to provide us with at this time.


You can submit your registration form now having completed just the above sections, however it would be beneficial if you could complete the rest of this form.

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

Tick here to agree to this statement I Agree



Family Details
Other Parent's Name
Mothers Occupation
Full or part time Full time Part time
Mothers Nationality

Fathers Occupation
Full or part time Full time Part time
Fathers Nationality
Will either parent be working from home? Yes No

Do any of your children have a disability? Yes No
If yes, please describe the disability and the care required.


Do your children have any allergies? Yes No
If yes, please provide details.


Household Details
Are any other staff employed to work at the house? Yes No
Are you a smoking household? Yes No
Do any have any household pets? Yes No
If yes, please provide details.


Will the carer be expected to help with the pets? Yes No
Childcare Requirements
Nursery Duties
Up keep of children's rooms Children's laundry Childrens ironing Childrens cooking
Childrens food shopping School runs
General Duties
All housework All laundry All ironing All cooking All shopping

Accommodation provided for live in postition
Self contained flat Own floor in house Bedroom Sitting room Own bathroon
Shared bathroon

Do you require the carer to work during the weekend? Yes No
If yes, how often?
Do you require the carer to babysit? Yes No
If yes, how often?
Do you require the carer to travel with the family? Yes No

Childcarer Profile
What do you require?

Qualified? Yes No
Minimum years experience
Minimum age
Non smoker Yes No
Would you consider a carer with their own child? Yes No Maybe
Do you require a carer who drives? Yes No
Can you provide a car? Yes No Maybe
Ideal characteristics of the carer


Additional perks you would like to mention


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

Tick here to agree to this statement I Agree