Nanny Application for Weddings and Parties

Date:

Mother's Name:	Work Phone:

Father's Name:	Work Phone:

Home Address

Street Address Address Line 2 City State ZIP Code

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.

Name of Hotel:

Where will services be needed(address)?

Phone:

I am interested in using this Agency for:

Day:	Date:	Time:	To:

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Children:

Name:	Age:	Date of Birth	Male or Female:

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What type of attire would you like your nanny to wear?

Please add anything that you feel is important for us to know concerning your children and your plans.

How did you hear about Nanny Nexus?

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).

I understand and agree to the above medical waiver
I do NOT agree to the above medical waiver

Nanny Nexus Temporary Services Client Understanding and Release:

Understanding between parties:

1. Agency agrees to make its best effort to locate temporary child caregivers for clients' child care needs on an as requested basis.

2. Client agrees to pay Caregiver directly for services rendered at least

$25.00 per hour for 1-2 children
$27.00 for 3-4 children
$30.00 for group care

This is with a minimum of 4 hours plus any parking charges.

3. Client understands that an agency fee will be charged to their credit card for every caregiver visit.

4. Client understands that the services provided by all caregivers associated with Agency must be contracted through the Nanny Nexus office. Client agrees that he/she will not hire or refer a Nanny Nexus caregiver to a third party without the consent of the Nanny Nexus. Client further understands that use of a Nanny Nexus caregiver without arranging the visit through Nanny Nexus will result in a charge of $1,000 for liquidated damages. Client further understands that Nanny Nexus will negotiate a reduced placement fee if client wishes to hire a caregiver on a regular basis.

5. Client understands that all caregivers working with Nanny Nexus are not employees of Nanny Nexus. Client understands that if they pay more than $1,600 per calendar year to any one caregiver they are responsible for withholding and filing employment taxes for that person.

6. Client agrees to forever indemnify, release and hold harmless Nanny Nexus, its agents, and employees 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.

Full Name:

Date Application Completed:

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I have read and understand the terms of the agreement.

Medication Release: (optional)

Nanny Nexus Temporary Services Client Understanding and Release:

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