Permanent Service Application

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)

PERMANENT SERVICES CLIENT UNDERSTANDING AND RELEASE:

Understanding between parties:

Please Read!

1. Metropolitan Nannies, LLC. (“Metropolitan Nannies”) agrees to make its best effort to locate temporary child caregivers (“Caregivers”) upon request by the below-signed client (“Client”).

2. Rate: Client agrees to pay Caregivers directly for services rendered at least $15.00 per hour for 1-2 children and $1.00 per each additional child per hour, with a four-hour minimum.

3. Client understands that a non-refundable agency reservation fee will be charged to Client’s credit card upon Metropolitan Nannies’ confirming Client’s reservation for a Caregiver.

4. Client agrees to notify Metropolitan Nannies of any job cancellation and authorizes Metropolitan Nannies to automatically bill client’s credit card a cancellation fee of $25 if client cancels a job after confirmation by a Metropolitan Nannies’ employee. If client cancels a confirmed reservation within 24 hours of the scheduled visit, Client will be charged for four hours of the Caregiver’s time in addition to the agency reservation fee. Client acknowledges that jobs placed with less than 24 hours advanced notice will incur a $25 surcharge to be automatically billed to client’s credit card in addition to any other applicable fees.

5. Client understands that the services provided by all Metropolitan Nannies‘ Caregivers must be contracted through the Metropolitan Nannies office. Client further understands that the use of a Metropolitan Nannies‘ Caregiver or the referral of a Metropolitan Nannies‘ Caregiver to a third party, without arranging the visit through Metropolitan Nannies, is considered “theft of services” and will result in a charge of $1,000 in liquidated damages.

6. In the event that Client wishes to hire a Caregiver on a permanent basis, Metropolitan Nannies agrees to negotiate with Client in arriving at an acceptable placement fee. Metropolitan Nannies‘ standard placement fee for a Permanent Caregiver (“Nanny”) is the greater of 15% of the caregivers annual gross salary or $4,000 for a full-time placement (30 or more hours per week) is the greater of 15% of the caregivers annual gross salary or $2,500 for a part-time placement (less than 30 hours per week).

7. Client understands that Metropolitan Nannies‘ Caregivers are not employees of Metropolitan Nannies. Client understands that Client may be responsible for withholding and filing employment taxes for each calendar year in which the Caregiver’s payments exceed the limits set forth in the Internal Revenue Code. Social Security numbers of caregivers must be obtained directly from Caregivers.

8. Client agrees to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims relating to or arising out of the services provided in by Caregivers.

TRANSPORTATION WAIVER (OPTIONAL):

I hereby give my consent for a Metropolitan Nannies’ caregiver to transport my child(ren) in her or my automobile. I understand that Caregivers with Metropolitan Nannies are not employees of Metropolitan Nannies and that Metropolitan Nannies is making no representation or warranties relative to the Caregiver’s suitability to transport my child(ren). Metropolitan Nannies is in no way responsible for the safety of my child(ren) while being transported in Caregiver’s or my family’s automobile. I agree to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims including injury to Client’s car or child(ren) while being transported by a Metropolitan Nannies’ Caregiver.

MEDICAL RELEASE (OPTIONAL):

I hereby give my consent for a Metropolitan Nannies’ Caregiver to administer medication to my child(ren). I understand that Caregivers with Metropolitan Nannies are not medically trained. I agree to indemnify, release and hold harmless Metropolitan Nannies, its agents, employees and officers for any and all claims relating to a Caregiver’s administering of medication to my child(ren).

APPLICATION – PARENTS

Permanent Service Application

PERMANENT SERVICES CLIENT UNDERSTANDING AND RELEASE:

TRANSPORTATION WAIVER (OPTIONAL):

MEDICAL RELEASE (OPTIONAL):