Clients hiring a full or part time nanny, please click the submit button and return to complete part 2.
Clients hiring a temp, please click the submit button and return to print temp agreement.
Primary Contact
Address
City, State, Zip
County
Relationship
E-mail
Work Phone
Home Phone
Cell Phone
Fax
Is this a private fax?
Should we call prior to faxing?
Secondary Contact
Address
City, State, Zip
Work Phone
Home Phone
Cell
What pets live in the house?
Will nanny be working at the primary residence? If not, please explain, give location and phone.
What are the names of the children requiring care? Age Date of Birth Sex
Does anyone smoke inside the home?
Do you want a nanny who will live-in, live out, no preference?
Would you hire a smoker who smokes only outside?
Is there usually someone home during nanny's working hours?
For how long do you anticipate employing your nanny?
Occasionally we accept a well seasoned nanny into our pool who wishes to bring her child. Fees are typically reduced by 10-15% Is this an arrangement you would consider?
Please click the boxes which apply:
Do you need:
What will Nanny's responsibilities be?
What else would you like us to know about your family? Please discuss any special needs.
I would like more information about these other services you offer:
Which of your friends or co-workers might like a call about the services we offer?
Name: Phone: Service:
How did you hear about American Domestic? If referred by a friend, please tell us who we may thank.
Testimonial:
About the Agency
As a protective mom
who didn't know where to look for quality help for my infant son, American Domestic Agency was
friendly and responsive to my needs, and helped me figure out exactly who the right person was for our family.
About the Nanny
Through ADA we found a part-time nanny that has become an essential part of our family. She is a responsible, trustworthy and caring person who appreciates our ever-changing schedule. The true testament is the smile on our son's face when she arrives; he has grown to love her over the past one and a half years.
