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Name
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Home Address, City and State
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Hotel Name & Address, Cell Phone
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Email Address
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Date you arrive & Depart
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Dates & Times you are requesting Care
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Names & Ages of Children
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Any Special needs or Medical
Conditions we need to know
about?
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Referral Fees & Agreement
I agree to pay Nanny Brokers USA a referral fee which depends on the nature of the temporary job. I understand the
referral fee will be due when the
temporary placement is filled. All services must be contracted through the office of Nanny Brokers USA. Any
arrangements made with the caregiver and
without Nanny Brokers USA knowledge will be charged the Temps referral fee on the Client’s credit card, as caregivers
are under contract to inform us of any
such arrangements.
Services
Nanny Brokers USA cannot guarantee the availability of a Temp Sitter. By submitting an online form the Client is not
guaranteed a placement.
Nanny Brokers USA is a referral agency only. The Client acknowledges that the Sitter is NOT an employee of Nanny
Brokers USA and that the Client, and
NOT Nanny Brokers USA is the employer of the Sitter. In no event shall Nanny Brokers USA be liable or otherwise
responsible for any action or performance
of the Sitter including without limitation, 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.
I have read and understand the Referral Fees, Services, and Nanny Brokers USA Agreement thoroughly, clearly
understand it, and accept and agree to all
terms and conditions
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Client Electronic Signature & Date -------->
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