Family Application Form

This form will only take a couple of minutes to fill out

First Name (required)

Last Name (required)

Mobile:

Home:

Email (required)

Address

Suburb

State

Postcode

D.O.B.




The Children

What is your relationship to the children needing care?

Parent Y
Legal Guardian Y
Relative Y
Other Y

Now tell us about the little ones

Please enter each child's full name and dates of birth below. If a child is known by any name other than their legal name, please include this name in brackets.

#1
#2
#3
#4
#5




Do they have any special needs or requirements?

YN

Any medical conditions, disabilities or illnesses?

YN

Do they have have any allergies?

YN

Are there any dietary restrictions for your children?

YN

Do any of the children take any medication?

YN

Will the carer be required to administer medication?

YN


“If you have selected ‘yes’ to any of the above, please elaborate.

What can you tell us about your children’s activities, interests and nature?

Do you have any pets in your household?

YN

Will the nanny/carer be required to drive?

YN

Will the nanny/carer be provided a vehicle to drive with?

YN




So How Can We Help You

What services are you interested in?

Nanny

Y

Mother's Helper

Y

Wedding/Event Care

Y

Governess

Y

Housekeeping

Y

Nanny Share

Y

Live out Nanny

Y

Live-in/Au Pair

Y

Tutoring

Y

Other

Y


 
What are the service details?

Ideal start date:

Days of Care:
Monday DayNight
Tuesday DayNight
Wednesday DayNight
Thursday DayNight
Friday DayNight
Saturday DayNight
Sunday DayNight


Job Description:

Please include as much information as possible about hours, duties, activities and more.




How did you find out about us?
Caregiver Y Google search Y
Facebook Y Gumtree Y
Parent/friend Y Word-of-mouth Y
Instagram Y Seek Y
Other Y




Please provide details of children's' GP below


Additional Comments:






Emergency Contact Details

In the case of an emergency we require a minimum of 1 emergency contact. Please ensure these details are correct

#1
#2


Additional Comments: