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Family Application

  • Best Time To Call:Email:
  • Her Occupation:Work Phone:
  • Cell Phone:Email:

  • His Occupation:Work Phone:
  • Cell Phone:Email:
  • Name:Age:Date of Birth:Male or Female: 
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  • Name:Age:Date of Birth: 
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  • Name:Kind of Pet:Age:Date of Birth:Male or Female: 
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  • Start Date requested:Kind of service:
  • (pick up/drop off kids from activities, pick up prescriptions, take pet to vet, drop of dry cleaning, etc.)
  • Nanny Nexus Full-Time/Part-Time Nanny Services Client Understanding and Release:

    Understanding between parties:

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

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

    3. 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 $2,500 for liquidated damages.

    4. In the event that Client wishes to hire a nanny referred by Nanny Nexus on a permanent basis client agrees to pay Nanny Nexus placement fee for a permanent Caregiver ("Nanny") is $1,400 for a part-time/full-time nanny. 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 anyone 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.

    5. 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. Nanny Nexus does not provide a refund for services already rendered.

    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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Telephone: 913-669-5355

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