Premier Nanny Network Parent Intake Form
Please fill out the following form if you are looking for childcare. It should only take a few minutes. 

Want to skip this step? That is fine too! Simply schedule a consultation and Brynn will handle the details :) 

If you are looking for elder care, please email Brynn: premiernannynetwork@gmail.com
Sign in to Google to save your progress. Learn more
Parent Names *
Parent Emails *
Parent Phone Numbers *
Home Address: Street, City/State, Zip *
How did you hear about Premier Nanny Network? *
Schedule Requirements  *
What schedule will best fit your needs? Please give details below. (ex: Monday-Friday 8am-5pm; Mondays/Thursdays/Fridays 6am-2pm, etc.)
Type of Care *
How many children do you need care for? *
Do any of your children require special care? *
Required
If yes to special care, please provide details.
Do any of your children have allergies to food or medicine? *
If yes to allergies to food or medicine, please provide details.
Will Caregiver need to drive children? *
If yes to driving and you expect caregiver to drive their own vehicle, are you aware of providing gas compensation?
Clear selection
Household duties expected *
Required
Experience level  *
Required
Aside from CPR certification, is there another level of certification you expect to qualify for this position? (nursing degree, early childhood education degree, first-aid/ EMT, educational background, special needs background, etc.) *
Work from home *
Pets *
Pet Care Requirements: please share what kind of pets and what kind of care they need if applicable.
Do you travel often *
Expected pay range *
PTO, health insurance, other: please describe what benefits you are offering for this position *
W-2 Taxes *
Have you worked with an agency before? If yes, which company? What feedback can you provide? *
Have you worked with a nanny before? If yes, tell us about your experience. What did you like? Not like? *
Discipline: have you discussed and thought about how you will ask the caregiver to handle discipline? Please provide details.  *
Any specific challenges or expectations you have for the nanny? *
Anything additional we should know about your family? *
Emergency Contact: please provide phone number, address, and email. 
Please provide at least two contacts at this time. 
 *
Do you consent to background checks? *
Is there anything else you think PNN should know before starting the process of finding your candidate? *
Are you able to offer references for the caregiver? (This is not usually required, but some high level professional nannies do inquire with references before accepting positions). *
Do you consent to Premier Nanny Network sharing these details with candidates during the process to ensure the best match? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms