Parents' Registration Form

Please complete the form below and click 'Send' to send your information to us.

Your details will be held in the strictest confidence and will not be shared with any third parties.

Before completing this form, please ensure you have read, and agree to, our Terms and Conditions.

*Your Name:

*Address (including postcode):

*Phone Number (Daytime):

Phone Number - Evening (if different):

Phone Number - Mobile:

*E-Mail Address:

* Child 1 Details:

Boy / Girl:

Name:

DOB:

Child 2 Details:

Boy / Girl:

Name:

DOB:

Child 3 Details:

Boy / Girl:

Name:

DOB:

Child 4 Details:

Boy / Girl:

Name:

DOB:

Please give details of any special needs:

Please give details of any animals in the household:

*Type of childcarer required:

*Live-in or Live-out?:

Live In Live Out

*Please give details of days and hours required:

*Salary

*Start Date (approx):

Do you require a driver?

Is there a car available?

Please note: some nannies are willing to use their own car to transport children. This must be arranged with the nanny at interview stage and a mileage allowance agreed.

*Do you work?

*How did you hear about Hertfordshire Nannies and Maternity?

Please give us any other details you feel may be relevant:

* I have read, and agree to, your terms and conditions

Yes No

To prove you're human please enter 53171 into the box:

* = required information