Questionnaire - FASTER DRAFT

Who is Care Provider?

Indicate the full name of a child care provider (the "Care Provider"):
Indicate the full residential address of a Care Provider:
Indicate a Care Provider's contact email address:

!
This email address will be used for communication between a Child Care Provider and a Client regarding the present Agreement.
Indicate a Care Provider's contact phone number:

Who are Parents?

This agreement is signed by:
- One parent only
- By both parents
Indicate a parent's full name:
Indicate a second parent full name:
Indicate the full residential address of a parent:
Indicate the full residential address of a second parent:
Indicate a parent's contact email address:

!
This email address will be used for communication between a parent(s) and a Child Care Provider regarding the present Agreement.
Indicate a parent's contact phone number:

General Details

Indicate the date on which the Agreement starts:

!
This is the date when this Nanny Contract becomes effective.
Select the state where a child (children) who needs child care or nanny services currently resides:

!
The laws of a state selected as an answer to this question will apply towards this Agreement.
Child care services are required for:
- For one child
- For several children
Indicate a child's full name:

!
This information should be given in accordance with a child’s birth certificate.
Select a child's date of birth:
List full names and dates of birth for all children who need child care or babysitting services:
How many minutes per day of screen time are allowed for a child?

Description of Services

Should a Care Provider provide any cleaning services (e.g., clean a child's room, put all toys in order, etc.)?
- No
- Yes
Should a Care Provider organize pick-ups and drop-offs to and from school/daycare for a child?
- No
- Yes
Should a Care Provider administer any medication for a child (e.g., antibiotics)?
- No
- Yes
Describe in detail which type of medication, when, and how it should be given to a child:
Should a Care Provider wash, fold, and iron a child's cloth on a regular basis?
- No
- Yes
Should a Care Provider cook fresh and healthy meals and snacks for a child?
- No
- Yes

Working Hours

Child care services should be provided:
- According to a fixed schedule
- On as needed-basis
- Other arrangement
Describe in detail a weekly working schedule, including exact dates and times:
Describe in detail the exact working schedule for a Care Provider:
Select the date of the first working day for a Care Provider:
Should a Care Provider keep a daily journal to include a description of all activities done with a child?
- No
- Yes

Payment Terms

Which type of fees applies towards provision of services?
- A fixed fee
- An hourly rate
- A daily rate
- A weekly rate
Indicate the amount of a fixed fee (in USD):
Indicate an hourly rate (in USD):
Indicate a weekly rate (in USD):
Indicate a daily rate (in USD):
How frequently a Care Provider should be paid?
- Every month
- Every week
- Every other month
Indicate acceptable payment methods:
Should a parent pay late fees in case of delay in payment?
- Yes
- No
!
A late fee, also known as a late payment fee, is an additional charge applied when a bill or payment is made after the due date.

It is a way for self-employed individuals to compensate for the financial impact of delayed payments and can be used to encourage prompt payment in the future.
Indicate the annual interest rate (in %), which apply as late fees:
Should parents cover in full additional expenses of a Care Provider (e.g., travel expenses, meals)?
- Yes
- No
Should a Care Provider be entitled to any other additional benefits (e.g., paid insurance, pocket expenses)?
- No
- Yes
List all available benefits a Care Provider should be entitled to:

Miscellaneous

Describe the name and location of the medical facility where a child should be brought immediately in case of emergency:
The child care services hereunder should be provided:
- Until specific date
- For a certain period of time
- For indefinite period of time
Select the date until which child care services should be provided:
Indicate a period of time (in months) for which child care services should be provided:
Will a Care Provider have any paid vacation or days off?
- No
- Yes
Indicate the number of calendar days of paid holidays or days off per year a Care Provider should have:

Do you want to add a signature?
- Yes
- No
Enter a Care Provider's signature:

Select a document's format:

PDF

DOCX

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Who is Care Provider?

Indicate the full name of a child care provider (the "Care Provider"):

Indicate the full residential address of a Care Provider:

Indicate a Care Provider's contact email address:

Indicate a Care Provider's contact phone number:

Who are Parents?

This agreement is signed by:

Indicate a parent's full name:

Indicate a second parent full name:

Indicate the full residential address of a parent:

Indicate the full residential address of a second parent:

Indicate a parent's contact email address:

Indicate a parent's contact phone number:

General Details

Indicate the date on which the Agreement starts:

Select the state where a child (children) who needs child care or nanny services currently resides:

Child care services are required for:

Indicate a child's full name:

Select a child's date of birth:

List full names and dates of birth for all children who need child care or babysitting services:

How many minutes per day of screen time are allowed for a child?

Description of Services

Should a Care Provider provide any cleaning services (e.g., clean a child's room, put all toys in order, etc.)?

Should a Care Provider organize pick-ups and drop-offs to and from school/daycare for a child?

Should a Care Provider administer any medication for a child (e.g., antibiotics)?

Describe in detail which type of medication, when, and how it should be given to a child:

Should a Care Provider wash, fold, and iron a child's cloth on a regular basis?

Should a Care Provider cook fresh and healthy meals and snacks for a child?

Working Hours

Child care services should be provided:

Describe in detail a weekly working schedule, including exact dates and times:

Describe in detail the exact working schedule for a Care Provider:

Select the date of the first working day for a Care Provider:

Should a Care Provider keep a daily journal to include a description of all activities done with a child?

Payment Terms

Which type of fees applies towards provision of services?

Indicate the amount of a fixed fee (in USD):

Indicate an hourly rate (in USD):

Indicate a weekly rate (in USD):

Indicate a daily rate (in USD):

How frequently a Care Provider should be paid?

Indicate acceptable payment methods:

Should a parent pay late fees in case of delay in payment?

Indicate the annual interest rate (in %), which apply as late fees:

Should parents cover in full additional expenses of a Care Provider (e.g., travel expenses, meals)?

Should a Care Provider be entitled to any other additional benefits (e.g., paid insurance, pocket expenses)?

List all available benefits a Care Provider should be entitled to:

Miscellaneous

Describe the name and location of the medical facility where a child should be brought immediately in case of emergency:

The child care services hereunder should be provided:

Select the date until which child care services should be provided:

Indicate a period of time (in months) for which child care services should be provided:

Will a Care Provider have any paid vacation or days off?

Indicate the number of calendar days of paid holidays or days off per year a Care Provider should have:

Do you want to add a signature?

Enter a Care Provider's signature:

Select a document's format: