Nanny Brokers Wedding  Service Agreement

Upon receiving this completed agreement , we will immediately begin to process your order.

Please complete this Agreement :

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 a Non Refundable $150.00 Booking Fee 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 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  Office 334 208-9877
email this completed form to    admin@nannybrokers.com



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