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Your Name
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Temp Registration Form
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Home Address
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Full address care is needed
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City, State, Zip
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E-Mail
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Home Phone #
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Cell Phone #
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BEST TIME TO CONTACT YOU
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Type Care you are seeking
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PLEASE LIST CHILD(REN) NAMES & AGES
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Any medical conditions or special needs?
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Registration, Referral Fees & Agreement
Upon registration, I agree to pay Nanny Brokers USA a annual registration fee of $95.00. I understand a $20.00 daily referral fee will be due for each day I
request a sitter. All services must be contracted through the office of Nanny Brokers USA. Any arrangements made with the caregiver directly and without
Nanny Brokers USA knowledge will be charged $50.00 per day on the Client’s credit card. All Sitters are under contract to inform us of any such arrangements.
Cancellations-There will be a $20.00 (Per Day) Cancellation Fee charged for any cancellations cancelled after a booking has been confirmed and a sitter
booked.
Services- Nanny Brokers USA will do their best to locate an confirm a sitter for you, however there are certain times we cannot guarantee the availability of a
Temp Sitter. Nanny Brokers USA is a referral agency only. The Client acknowledges and understands that the Sitter is NOT an employee of Nanny Brokers
USA .I understand that Nanny Brokers USA is NOT liable or otherwise responsible for any action or performance of the Sitter including without limitation, to the
Sitters negligence, malfeasance, or willful misconduct. The client on behalf of itself and all successors and assigns agrees to forever indemnify, release and
hold harmless Nanny Brokers USA, it's directors, agents, employees and officers for any and all claims action, and causes of action whatsoever arising out of
or in any way connected with the performance of or services provided by the caregivers.
By signing this , I agree I have read and understand the Referral Fees, Services, and Nanny Brokers USA Agreement thoroughly. I agree I clearly understand
it, and accept and agree to all terms and conditions above.
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Electronic Signature & Date ------->
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