Where did you hear about Thank Evans?
Mother's title Miss Mrs Ms Other
Mother's Name
Father's Name
Address
Postcode
Fax
Mother's occupation
Mother's work tel
Would you prefer invoices by email? Yes No
Family nationality
Home telephone no.
Mother's mobile no.
Father's mobile no.
Email address
Father's occupation
Father's work tel
Alternative Emergency name
Alternative Emergency tel
Family religion (and any bearing this may have on daily life)
Do you have pets
Name
Gender: Male Female
Date of birth / /
Are more children expected?(Please give details)
Children's GP's name
Children's GP's tel
Children's GP's address
Does your child have any...
Allergies (including any treatments)
Medications
Phobias
Comforters
Other
Candidates to be employed by Thank Evans - please see accompanying documents labelled R/F
Permanent - please give start date / / (DD / MM / YYY)
Temporary - please give length of cover
Ad-hoc - please give any available information
Nanny Maternity nurse Mother's help Baby sitting Overnight care Night feeds
Other (please specify)
Full-time Part-time Evenings Weekends Live-in Live-out Sole-charge To work alongside parent
Days required
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Qualifications required Yes No Prefs:
Driver required Yes No With car Family car available for work use
Horse rider First Aid Trained Non Smoker Swimmer / Active person
Any special requirements
Light housework Family Ironing School runs Pet care Nursery Duties only (i.e. children's ironing / washing / cooking / tidying)
Other Duties (please specify)
Other Information (please give a breif outline of daily routines, or other information we may require)
Please tick this box if you would like Thank Evans to place a specific Classified Advertisement regarding your childcare position (see Terms of Business R/F clause 3.9).
I confirm that I have read, understood and agree to the enclosed Terms of Business including the current fees table of Thank Evans Nanny Agency.
I confirm that I will pay the registration fee and therefore that I am asking the agency to put our family in contact with potential applicants.
I understand that should any details that have been given above change or should I locate and secure childcare elsewhere that I should inform the agency as soon as possible.
I understand that I should contact Thank Evans within 24 hours after meeting applicants so as to discuss opinions and consequent actions.
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