First Name:

Surname:

Address:
Post Code:

Home Phone:

Work Phone:

Mobile:

Fax:

Email:
 



Mums occupation:

Business name:

Business address:

Phone: Direct line:

Fax: Email:

Work:

Dads occupation:

Business name:

Business address:

Phone: Direct line:

Fax: Email:

Work:
 

Name:

Age: DOB: Sex:

Name:

Age: DOB: Sex:

Do the children have any medical conditions/disabilities or special requirements?

Yes (if yes, please state below)

Do the children have any allergies?

Yes (if yes, please state below)

Any dietary restrictions?

Yes (if yes, please state below)

Do the children take any medication?

Yes (if yes, please state below)

Will the carer be required to administer this medication?

Yes (if yes, please state below)

Do the children have any special interest/activities that they enjoy or attend?

Yes (if yes, please state below)

Will the carer be required to accompany them to these activities?

Yes (if yes, please provide details of days and times below)

Monday:
Tuesday:
Wednesday:
Thursday:
Friday :
Saturday:
Sunday:



Days and times required to share. Please provide times in the space provided.

Monday:
Tuesday:
Wednesday:
Thursday:
Friday :
Saturday:
Sunday:

Where do you prefer the care to take place?

What do you suggest?

Food to be provided & prepared by the parent/s? eg Lunch box: Yes No

Food to be provided by the parents of the child/children home? Yes No

Money to be put into kitty per week & carers buys & prepares food for the children? Yes No

Other (Please provide details):



Do you believe that children should have free play? Yes No

Do you believe that children should have schedule activities? Yes No

Do you believe that the children should stay at home? Yes No

If no what activities do you suggest? (local park, Picnics, Southbank, Museum, Science centre etc)



Please provide us with your comments & suggestions regarding discipline?

What forms of discipline do you suggest? Please provide details (eg Naughty corner,or chair)



Any additional information you would like to add. Please state?

I the undersigned have filled in the application to the best of my knowledge to enable Care For Kidz to find a suitable parent/guardian to share a nanny with. I the undersigned has read, signed, dated and understood the Terms and Conditions set out by Care For Kidz and enclosed them with this application.

Parents Name:

Address:

Before submitting, please be sure that all information you can enter is correct.
If any necessary fields are left blank a Care for Kidz representative will be in touch
as soon as possible to clarify.