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Family Registration Form

Surname
First Name
Title
Address
   
Postcode
   
 
Telephone Number
Work Telephone
Fax Number
Email
       
Mother's Occupation
Father's Occupation
Nationality
Nationality
Age
Age
Child's Name
 DOB Gender
Child's Name
 DOB Gender
Child's Name
 DOB Gender
Child's Name
 DOB Gender
Is there any physically/mentally disadvantaged person in the household? Please Select
Do any of your children have special needs or specific learning difficulties? Please Select
Help Required
Please Select
Qualification Required
Please Select
Live in
Please select
     
Will the applicant have sole charge of children for long periods (i.e. if both parents are working)?
Please Select


Is there a new baby expected?  If so,
when?
Date


Would the applicant be expected to deal
with him/her?
Please Select


 
Please give details of any household staff currently employed
Staff Currently Employed


Do you have pets?
Please Select
If yes please give details...
Pet Details


What are the hobbies/interests within the family?
Family Interests


What type of home do you have?


Do you have any special facilities (Tennis Court, Swimming Pool, etc)?

Please Select


What accommodation is available if live-in help required? 
Please Select


Would you prefer a non-smoker?
Please Select


Which age would you prefer?
Please Select


Would you require a car driver?
Please Select


Is there a car available for the nanny?


Please Select

What duties will be required?
Childcare
Children's Cooking
Family Cooking
Driving Children
Light Housework
Shopping
Children's Ironing
Family Ironing
       
Salary Offered Preferred Start Date
Duration of Employment
   
When you are away on holiday will you expect to take the nanny with you? Please Select
Have you previously employed anyone to help with your children? Please Select
If ‘Yes’ how long were they employed by you? Length of Employment
Are you happy for your telephone number to be given
to prospective applicants?		 Please Select

Are you happy for Family Match to advertise this position on your behalf?

Please Select

How did you hear of Family Match?

 Please Select
Other - please specify

Please give name and address of an unrelated person who we may contact to obtain a family reference:
In what capacity do you know this person? Please Select
Other - Please specify


Thank you for completing this form... Please print the form and send to Family Match, address below, having completed the following section.

I confirm that all information supplied to me is confidential and that should I effect any form of introduction, either direct or indirect, of an applicant to a Third Party, that I will be responsible for their full introductory fee.

I have read, understand and accept the terms and conditions of your agency and confirm that the information given above is true.

I enclose £30.00 registration fee (includes VAT).

 

If you do not want to receive information about special offers and newsletters please tick the box 

 

Signature: ……………………………………………………….….

 

Date: ………………………………..……

 

For Office use only:

FM Family Ref No:

 

Date Form Received

Reg. Fee Paid:

 

Client Club Membership No:

 
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