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  • Mother's Name:Work Phone:
  • Father's Name:Work Phone:
  • Home Phone:Mobile Phone:

  • Note: A credit card is REQUIRED for Agency services. ONLY Mastercard and Visa are accepted. A Nanny Nexus representitive will contact you for your credit card information.

  • Location:Phone:
  • Hotel Reservation Name:Arrival Date:
  • Arrival Time:Room Number:

  • Day:Date:Time:To: 
    Press the "+" for more

  • Name:Age:Date of Birth:Male or Female: 
    Press the "+" for more

  • Medication Release: (optional)

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

  • Nanny Nexus Temporary Hotel Services Client Understanding and Release:

    Understanding between parties:

    1. Nanny Nexus agrees to make its best effort to locate temporary child caregivers for client's child care needs on an as requested basis.

    2. Client agrees to pay caregivers directly for services rendered at least
    • •$22.00 per hour for 1-2 children and
    • •$25.00 per hour for 3-4 children,
    • •$30.00 for group care(5 or more children), with a four-hour minimum.

    3. Client understands that they need to pay the agency fee for every confirmed reservation. Credit card payment is preferred on the website. (www.nannynexus.com)

    4. Client understands that if s/he cancels a caregiver who has already been confirmed by Nanny Nexus s/he will be charged the agency reservation fee. Client further understands that if canceling with less than 24-hour notice, s/he will be charged the four-hour minimum for the caregiver in addition to the agency reservation fee. Cancellations must be made to Nanny Nexus 24-hours prior to service; or by 4:00 pm Friday for a Saturday, Sunday or Monday on all temporary jobs to avoid payment to the nanny/caregiver. A temporary placement greater than 6 days requires a one-week prior cancellation. Failure to cancel within the prescribed time frame will result in payment to the nanny/caregiver of:
    • • 25% of potential earnings for temporary jobs 10 days or shorter
    • • One-week severance pay for temporary jobs over 10 days in length
    • • Up to $75 of the agency fee is non-refundable, if the client cancels

    5. The fees are time and a half on holidays (New Year's Eve, Valentines Day, Memorial Day, Labor Day). If a child is driven mileage should be paid to Nexus temp. If the child is sick Nexus Temp is paid an additional 20% = $12 hour for one child.

    6. Client understands that the services provided by all caregivers referred by The Agency must be contracted through The Agency office. Client further understands that the use of an Agency caregiver, or referral of an Agency to a third party, without arranging the visit through the agency, is considered "theft of services" and will result in a charge of $1,000 for liquidated damages.

    7. In the event that Client wishes to hire a nanny referred by Nanny Nexus on a permanent basis, Nanny Nexus agrees to negotiate with the client in arriving at an acceptable placement fee. Nanny Nexus standard placement fee for a permanent Caregiver ("Nanny") is $1,100 for a part-time/full-time nanny.

    8. Client understands that caregivers working with Nanny Nexus are not employees of Nanny Nexus. Client understands that if they pay more than the allotted government amount per calendar year to any one caregiver s/he is responsible for withholding and filing employment taxes for that person. Social Security number of caregivers must be obtained directly from caregivers.

    9. Client agrees to forever indemnify, release and hold harmless Nanny Nexus its agents, employees, and officers for any and all claims relating to services provided by caregivers.

    By typing your name and submitting the form as completed above, you agree that you have read and agree with the information on this form. You also agree to comply with it, and agree to pay any applicable fees, listed above.
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