FAMILY REGISTRATION FORMFamily details:Mother’s Name:_____________________________________________________________________...
__________________________________________________________________________________________________________________________...
__________________________________________________________________________________________________________________________...
I agree to engage Little Cherub as sole Nanny Agency benefitting from the discountrates (please tick the box if you wish t...
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Little cherub registration form v1

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Family Registration Form

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Little cherub registration form v1

  1. 1. FAMILY REGISTRATION FORMFamily details:Mother’s Name:_________________________________________________________________________Mother’s Nationality:_____________________________________________________________________Contact Telephone Number: Work __________________________________ Mobile ________________________________ Landline _______________________________Mother’s Email Address (please use capital)______________________________________________Father’s Name:__________________________________________________________________________Father’s Nationality:______________________________________________________________________Contact Telephone Number: Work _________________________________ Mobile _______________________________ Landline ______________________________Father’s Email Address (please use capital)________________________________________________Family Address:____________________________________________________________________________________________________________________________________________________________________________________Any hobbies or family interests?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do any family members smoke?__________________________________________________________________________________________Do you have any pets? If so, please specify_______________________________________________Languages spoken in the household______________________________________________________Children’s Information:Name and Date of Birth of Children: Name of Child __________________ Date of birth __________________ Gender ________ Name of Child ___________________ Date of birth __________________ Gender ________ Name of Child ___________________ Date of birth __________________ Gender ________Ethnic & Religious/ Background___________________________________________________________Child’s medication requirements: HANDLED WIT H CARE
  2. 2. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Child’s food intolerance:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Child’s allergies:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please provide information about your child’s general routine:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Any additional Information you feel is important:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Nanny Requirements:Please circle:Do you need? Nanny Mothers Help Maternity NurseLive in Live outPermanent TempFull Time Part TimeDesired starting date:____________________________________________________________________Salary offer: _________________________________ net / gross (please circle)Length of employment required (min/max):_______________________________________________Tax is required to be paid by employers. The agency can provide you with full details on howto process Tax and National Insurance.Dates and times do you require your nanny/mothers help/Maternity Nurse to work?Monday Tuesday Wednesday Thursday Friday Saturday SundayTimesPlease give details of duties you require the nanny/mothers help to undertake: HANDLED WIT H CARE
  3. 3. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do you need a driver? Y NIf so, will a car be provided? Y NWill you consider a male carer? Y NWill you require a carer with a first aid certificate? Y NWill you require a carer with childcare qualifications? Y NWill you require your carer to travel on holidays with the family? Y NIf you require a live in nanny please give information about the accommodation provided(E.g. own bathroom, etc):______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Do you employ other staff in your home?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Have you employed a nanny/mother’s help/Maternity Nurse before? (If yes, pleasecomment on your experience)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional Information:Do you give the Agency consent to advertise your position? Y NDo you consent for Little Cherub to give your details to potential candidates? Y NPlease give us any other information you consider important for the agency to find the rightcandidate for you_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HANDLED WIT H CARE
  4. 4. I agree to engage Little Cherub as sole Nanny Agency benefitting from the discountrates (please tick the box if you wish to use this option)I hereby understand and agree to the terms and conditions and give my consent to theAgency to use my details. I also confirm the above information is correctPrint Full Name:__________________________________________________________________________________________Position in household:_____________________________________________________________________Signed:___________________________________________________________________________________Date:____________________________________________________________________________________ HANDLED WIT H CARE

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