Childcare Resources On-Call Babysitting Application

3070 Windward Plaza, Suite. F-352
Alpharetta, GA 30005
Phone: (770) 619-0377 Fax: (770) 619-5777
www.ChildcareResources.com
crinannies@bellsouth.net

Placement Agreement

Please click on the link to the Placement Agreement and:

1). Review prior to submitting;

On-Call Babysitting Placement Agreement
or
Temporary Babysitting Placement Agreement

2). Print and complete Placement Agreement;
3). Fax it to our direct, private fax at (770) 619-5777.
4). Fill out form below and submit

BABYSITTING APPLICATION
PLEASE FILL IN ALL APPLICABLE FIELDS.

Date

Last Name

First Name

Phone

home cellular

Fax Number

Email Address

Marital Status

Single Married Divorced

Spouse's Name (if applicable)

Family's Address

City

State

Zip Code

EMPLOYMENT INFORMATION

Employer

Work Phone

Work Address

City

State

Zip Code

Spouse's Employer

Spouse's Work Phone

Spouse's Work Address

City

State

Zip Code

SERVICES REQUESTED

Type of care requested

Weekends Weekdays Overnight

Babysitting package

On-call Solution

Desired Start Date

Note: We cannot guarantee a placement by the start date; but we will do our very best. Placements of caregivers generally take between (2) to (8) weeks.

Caregiver's Work Schedule

Are these hours flexible?

Explain

CHILD/CHILDREN

Child/Children's Name

NAME	GENDER	AGE	SCHOOL (if applicable)
NAME	GENDER	AGE	SCHOOL (if applicable)
NAME	GENDER	AGE	SCHOOL (if applicable)
NAME	GENDER	AGE	SCHOOL (if applicable)
NAME	GENDER	AGE	SCHOOL (if applicable)
NAME	GENDER	AGE	SCHOOL (if applicable)

INSTRUCTIONS FOR CHILDCARE

Do you have a pool?

Does anyone in your household smoke?

Note: This is a smoke-free nanny agency, and we seek non-smoking caregivers. From past experience, we know that most parents are not interested in caregivers that smoke; however, we can not always guarantee that all registered caregivers do not and will not smoke.

Do you have any pets? If "yes" describe your pets?

Do you have a special religious observance?

If "Yes" explain

Do any of your children have special needs including special education or behavioral management?
Note: If "yes" explain if the caregiver needs to administer medication. If this is applicable, please include this information; nannies often get discouraged, overwhelmed, and sometimes quit when this information is withheld. We appreciate knowing this information beforehand so that we can inform the candidate(s)

If "yes" please explain

Describe the best nanny for your family.
Please inform us if you have an ethnicity preference, or if a nanny "must have" certain requirements. In our search, we cant' always guarantee that we will be able to exactly match your detailed request within a specific time frame. We will, however, try our best in our search and referral process.

Note: Please understand that the on-call babysitting service is provided on a "first call, first served" basis.
We cannot guarantee the same caregiver(s) for this service, but we try our best.

Please provide directions to your home or office from the nearest highway.
(I-285, I-85, I-75, I-20, or GA-400)

How did you hear about Childcare Resources, Inc.?

Yellow Pages   News Media   Internet   Magazine:

Personal Referral from:
    They are current clients on file.

Thank you for your trust and confidence in our service. We appreciate your patronage.

I have fully reviewed all of the terms of this application and agree to them all.