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Application Date
Mother's Name
Place of Employment
Work Phone
Cell Phone
E-mail address
Father's Name
Place of Employment
Work Phone
Cell Phone
E-mail address
Home Address
Home Phone
Preferred method of contact
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I am interested in using Agency for:
as needed nanny care
Evening sitting only
1-6 week placement
2-3 month placement
Please describe your children:
Name Birth Date Gender
Please list any pets:
(Please update Monticello Nannies regularly with new children, addresses, phone numbers, credit card numbers and pets.)
Please add anything that you feel is important for us to know concerning you and your family.
How did you hear about Monticello Nannies?

PART 3: Monticello Nannies Temporary Services Client Understanding and Release:

Initial Understanding between parties:

Monticello Nannies agrees to use all reasonable efforts to locate temporary child caregivers for client’s child care needs on an as requested basis.

Monticello Nannies agrees to disclose all material information about our nannies acquired by Monticello Nannies throughout the qualification process.  Any nanny who is referred by Monticello Nannies has met or exceeded the requirements set forth in the qualifying process.

Client agrees to pay caregivers directly for services rendered with a four-hour minimum at a rate agreed upon in advance by the nanny and the client.

Client understands that Monticello Nannies collects an annual registration fee for our Temporary/On-Call Services and that a small agency fee will be charged to their credit card for every confirmed reservation.  These fees vary with the type of service the client registers for.  A detailed service agreement which lists all fees will be discussed with client and signed before service from Monticello Nannies begins.

Client understands that if s/he cancels a caregiver who has already been confirmed by Monticello Nannies, s/he will be charged the agency reservation fee.  Client further understands that if canceling with less than 4-hour notice, s/he will be charged half of the four-hour minimum for the caregiver in addition to the agency reservation fee . 

Client understands that the services provided by all caregivers engaged through Monticello Nannies must be contracted through the Monticello Nannies office.  Client agrees that s/he will not hire or refer a Monticello Nannies caregiver to a third party without the consent of the Monticello Nannies office.

Likewise, Monticello Nannies will not disclose to any third party, other than as necessary to perform services pursuant to the services agreement, any personal or identifying information provided to Monticello Nannies by client. 

Client understands that caregivers working with Monticello Nannies are NOT employees of Monticello Nannies.  Client understands that if they pay more than $1600 per calendar year to any one caregiver, client is responsible for withholding and filing employment taxes for that person.  Social Security number of caregivers must be obtained directly from caregivers. 

Client agrees to forever indemnify, release and hold harmless Monticello Nannies caregivers, as well as Monticello Nannies, its agents, employees, and officers for any and all claims relating to services provided by caregivers.

I agree
I do not agree


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•288 Fieldstone Drive, Keswick, Virginia 22947
Phone: 434-923-0023 • info@monticellonannies.com