Hotel  REGISTRATION FORM
Name
Home Address, City and State
Hotel Name & Address, Cell Phone
Email Address
Date you arrive & Depart
Dates & Times you are requesting Care
Names & Ages of Children
Any Special needs or Medical
Conditions we need to know
about?
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 booked, I understand this fee is NON- Refundable.
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 a fee of $100.00 referral fee on the Client’s credit card, as
caregivers are under contract to inform us of any such arrangements.

Temp Service Agreement
Nanny Brokers USA will do their best to locate you a sitter but at certain times cannot guarantee the
availability of a Sitter.  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 temp  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 and 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,
and I clearly understand it, accept to it ,and agree to all terms and conditions
Client Electronic Signature & Date -------->