Family Intake Form

Parent(s) Name:

Phone:

Email:

City:

Zip Code:

Best way to contact you.

Preferred start date.

Type of nanny you're looking for.

Number of children and their ages.

Language preferences (if any).

Any special needs or considerations (eg, allergies, m. conditions)

Driving required?

Pets in the home?

If Yes, Please specify)

Any cultural, parenting, or faith-based preferences you'd like your nanny to align with?

Household duties expected (light housekeeping, meal prep, etc.)

Hourly rate range ($25 - $35/hour)

Paid vacation.

If yes, how many days?

Paid holidays.

If yes, which holidays?

Sick days.

If yes, how many per year?

Guaranteed hours.

Will the nanny be paid for agreed hours even if not needed?

Overtime pay.

What rate, if applicable?

Health benefits or stipend .

If yes, what is the monthly rate.

Other benefits or bonuses offered (Open space).

Anything else you’d like me to know?