Names & Ages of children     Personality, special needs and/or concerns

Describe the characteristics of a provider who could best meet your needs.

Please choose the type of care you are interested in at this time.

Family Home Child Care
Hours:                                   Days:                                   Cost:                                  
What towns would you like your Child Care?                                                               

Please continue for Nanny only: (circle) Live IN or OUT       Full time(30+) or Part time
Check the duties you will be expecting Nanny to perform.
( )Light House work     ( )transporting children     ( )grocery shopping
( )Prepare meals           ( )children's laundry         ( )pet care
Nannies who desire to bring their own child with them must meet specific qualifying criterion.
Would you consider this type of caregiver?     Yes     No     Possibly

Describe other duties:

JoAnn Bergeron    PO Box 1382, Amherst, NH 03031-1382   (603)471-1415    Fax(603)471-1416    manager@AmericanNanny.com