Sunset Babysitting Agency - Family Application Form
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Parent/Carer name 1
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Parent/Carer name 2
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E-mail address
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Home address
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Home telephone number
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Parent/Carer 1 mobile number
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Parent/Carer 2 mobile number
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Is the babysitting to take place in your:
Home
Friend's Home
Holiday Home
Hotel
Other
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Holiday/other accommodation address and details:
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What language(s) does your family speak?
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Child 1: name, D.O.B, hobbies and interests:
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Child 2: name, D.O.B, hobbies and interests:
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Child 3: name, D.O.B, hobbies and interests:
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Child 4: name, D.O.B, hobbies and interests:
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Do any of your children have special needs, medical problems or allergies?
Yes
No
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If any of your children have special needs, medical problems or allergies, please provide details below:
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If there is anything else you feel we should know about your child, please provide details below (i.e. 'wets the bed regularly' etc.):
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Do you have any pets?
Yes
No
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If yes, what animals do you have? Please provide details, including where they are kept:
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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:
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Please use this space to provide us with any additional information which will help us provide the right babysitter for your family:
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Do you wish to book a:
Qualified and Experienced Babysitter over 21 years old
Qualified and Experienced Babysitter under 21 years old
Experienced Babysitter
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Please state the date(s) and times you require the babysitter:
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Please state how you wish to pay agency fees:
I wish to pay using a credit/debit card (please note there will be an additional 4% fee added)
I wish to pay by standing order
I wish to send a cheque
I wish to make a direct transfer
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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 £15 for a one-off booking
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How did you hear about Sunset Babsyitting Agency?
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Would you like details of our Nanny Agency?
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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:
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I give permission for my details to be passed onto the babysitter(s) who will be caring for my child(ren):
Yes
No
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I will always follow the Terms and Conditions of Sunset Babysitting Agency:
Yes
No
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Print name
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Date
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