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Nanny Brokers Special Event  Service Agreement

Upon receiving this completed agreement , we will immediately begin to process your order.
We will call you to confirm your order.


Please complete this Agreement : (please call to fax in this form BEFORE you use us)

Client Name___________________________________________
Address______________________________________ City__________State_____Zip______

Phone#_________________________Cell #_____________________________

How did you hear about us?________________________________________

Event Location___________________________________
Address___________________________________City __________
Phone_____________

Date's of service requested _______ _______ _______ ______ ______ ______

Times needed                     _______  _______  _______  ______ ______ ______

Names an ages of children seeking care :

1. _______________________________Date Of Birth ________Age________
2._______________________ ________Date Of Birth ________ Age_______
3.________________________ _______Date Of Birth ________ Age_______
4.________________________________Date Of Birth ________ Age_______
5. _____________________ __________Date Of Birth ________ Age_______
6._____________________ ___________Date Of Birth ________ Age_______
7._____________________ ___________Date Of Birth ________ Age_______
8._____________________ ___________Date Of Birth ________ Age_______
9._____________________ ___________Date Of Birth ________ Age_______
10.____________________ ___________Date Of Birth ________ Age_______

NOTE If more space is need please write on back of page

Any special needs?______________________________________
(medical problems, allergies, behavior concerns, medication,etc?)__________

Job descriptsion:_________________________________________________________

Please Initial all below:

___I Understand the one time $125.00 Booking fee is NON refundable,and is due when I sign up and
agree to use the service .
___I understand that if I cancel or do not use the agencies services  that the agency offers no refunds.
___I understand that all request for service MUST be booked directly with the agency.
___ I understand that there will be a per hour charge, per child please refer to the price list below

Price Per hour (Per Child)  (4 hour Min ) charged  ***  

5-10 children $12.00 per hour per child

11 or more  $10.00 per hour

to be paid 2 days Before the Event


I HAVE READ , UNDERSTAND AND AGREE TO THE AGENCY POLICIES STATED ABOVE.


Family
Signature______________________________________________________Date___________________


Office use only
Acct #__________________

Application received_______________ expires___________

Paid $_______ Check __________ Money Oder______
Credit Card _______________________Exp__________

OFFICE use
Sitters Booked
1 _________________________________________date_______ Fee____
2_________________________________________date_______ Fee____
3 _________________________________________date________Fee____
4 _________________________________________date________Fee____
5__________________________________________date________Fee____
6__________________________________________date________Fee____
7__________________________________________date________Fee____
8__________________________________________date________Fee____
9__________________________________________date________Fee____
10_________________________________________date________Fee____




Nanny Brokers USA P.O. Box 131 Lilburn , Ga. 30047 (678)380-7158 Fax after 7 PM  to
(678) 380-7158
admin@nannybrokers.com