Sunset Babysitting Agency - Family Application Form

Parent/Carer name 1 *

Parent/Carer name 2 *

E-mail address *

Home address *

Home telephone number *

Parent/Carer 1 mobile number *

Parent/Carer 2 mobile number *

Is the babysitting to take place in your: *

Holiday/other accommodation address and details: *

What language(s) does your family speak? *

Child 1: name, D.O.B, hobbies and interests: *

Child 2: name, D.O.B, hobbies and interests: *

Child 3: name, D.O.B, hobbies and interests: *

Child 4: name, D.O.B, hobbies and interests: *

Do any of your children have special needs, medical problems or allergies? *

Yes

If any of your children have special needs, medical problems or allergies, please provide details below: *

If there is anything else you feel we should know about your child, please provide details below (i.e. 'wets the bed regularly' etc.): *

Do you have any pets? *

Yes

If yes, what animals do you have? Please provide details, including where they are kept: *

In the unlikely event of an emergency, we request you provide us details of a person we could contact if you are unreachable. Please provide their name, relation to you, address and contact numbers: *

Please use this space to provide us with any additional information which will help us provide the right babysitter for your family: *

Do you wish to book a: *

Qualified and Experienced Babysitter over 21 years old

Qualified and Experienced Babysitter under 21 years old

Experienced Babysitter

Please state the date(s) and times you require the babysitter: *

Please state how you wish to pay agency fees: *

I wish to pay by standing order

I wish to send a cheque

I wish to make a direct transfer

Please state how much you wish to pay: *

I wish to pay a yearly registration of £150

I wish to pay a monthly fee of £13.50 every month

I wish to pay £16.50 for a one-off booking

How did you hear about Sunset Babysitting Agency? *

Would you like details of our Nanny Agency? *

Do you know any other families who may be interested in registering with either our Babysitting or Nanny Agency? If 'yes', please provide their name and contact details: *

I give permission for my details to be passed onto the babysitter(s) who will be caring for my child(ren): *

Yes

I will always follow the Terms and Conditions of Sunset Babysitting Agency: *

Yes

Print name *

Date *

Report abuse