Mother's First Name:

Mother's Last Name:

Occupation:

Place of Employment:

Work Phone:

Mobile Phone:

Email Address:

Father's First Name:

Father's Last Name:

Occupation:

Place of Employment:

Work Phone:

Mobile Phone:

Email Address:

Home Address:

Address Line 2:

City:

State:

Zipcode:

Home Phone:

Best Time to Call:

Best Person to Call:

Emergency Contact (Other than Parents):

Have you ever employed a nanny? Have you ever employed a nanny? Yes No

If yes, please describe relationship:

YOUR CHILDREN: Please describe your children below:

Child #1 Name:

Child #1 Birthdate (Month/Day/Year):

Child_#1 Gender: Child_#1 Gender: Male: Female:

Child #1 School Hours:

Child #2 Name:

Child #2 Birthdate (Month/Day/Year):

Child_#2 Gender: Child_#2 Gender: Male: Female:

Child #2 School Hours:

Child #3 Name:

Child #3 Birthdate (Month/Day/Year):

Child #3 Gender: Child #3 Gender: Male: Female:

Child #3 School Hours:

Child #4 Name:

Child #4 Birthdate (Month/Day/Year):

Child #4 Gender: Child #4 Gender: Male: Female:

Child #4 School Hours:

FAMILY PETS: Please list below any pets that you have in the home:

Pet #1 Name:

Pet #1 Type/Breed:

Please list any important information that we should know about this pet::

Pet #2 Name:

Pet #2 Type/Breed:

Please list any important information that we should know about this pet::

Pet #3 Name:

Pet #3 Type/Breed:

Please list any important information that we should know about this pet::

Pet #4 Name:

Pet #4 Type/Breed:

Please list any important information that we should know about this pet::

Do any other family members or friends live in your home (e.g. grandparents)? Do any other family members or friends live in your home (e.g. grandparents)? Yes No

Will they be there when the caregiver is present? Will they be there when the caregiver is present? Yes No

IF YES...Please list family members and/or friends below:

Name:

Relation to Family:

Please describe situation:

Name:

Relation to Family:

Please describe situation:

Name:

Relation to Family:

Please describe situation:

Name:

Relation to Family:

Please describe situation:

Does anyone in your home smoke? Does anyone in your home smoke? Yes No

Please add anything that you feel is important for us to know concerning you and your family:

Nanny Information (Please Check): Nanny Information (Please Check): Live Out Live In Summer Full-time Part-time

Nanny Pay - Weekly Gross (Before taxes):

Weekly Net:

Benefits (vacation, holidays, health insurance):

Please Describe:

Please check all of the duties you would like your nanny to perform related to the child(ren): Please check all of the duties you would like your nanny to perform related to the child(ren): Child(ren)'s Laundry Bathing Preparing Meals Daily Log of Child(ren)'s Play Picking up after Child(ren) Reading to Child(ren) Age-appropriate Activities Other (Please describe):

Will you provide a car for your nanny? Will you provide a car for your nanny? Yes No

If yes, please describe:

Do you want your nanny to transport your child(ren)? Do you want your nanny to transport your child(ren)? Yes No

If yes, please describe:

Will you reimburse your nanny for mileage? Will you reimburse your nanny for mileage? Yes No

If yes, at what rate?

Please describe the personality of the nanny that would best suit your family needs (athletic, outgoing, laid-back):

Please describe a typical day in your home:

Please describe any special requirements you are looking for (i.e. religion, education, experience):

Please describe your discipline style:

If you are looking for a live-in nanny, please describe living accomodations:

How did you hear about Metropolitan Nannies? (Required)