MPS Best-Care

PERSONAL INFORMATION:   

Email address:

First and Last Name: 

Employer: 

Position:   

Spouse Name: 

Street Address:   

City/Town/Village:

Province/State:    

Postal/Zip Code: 

Country:                 

Home Phone:       

Fax:                        

Cell Phone:           

Business Phone:  

Best time to reach you: 

TYPE OF CAREGIVER NEEDED

(Please check care needed and the corresponding applicable household duties in the space provided)

1. Nanny

2. Elder Care

3.Disabled

4.Special needs

5.Physically Handicapped 

Our full-time live-in caregivers work 44 hours a day, five days a week, usually Monday to Friday.  Please specify work hours, days off, or additional work days if variable.   

Indicate number of children and their ages; boys or girls;

Do they attend day care Yes     No

Do any of your children have specific/needs Yes     No    

If yes, describe.

Will you provide a "nanny car"? Yes     No

What type of accommodation do you have for the caregiver?

Private bedroom with bath.   Private bedroom with shared bath.   

Describe any special feature of the nannies accommodation.  A carriage house, basement, separate apartment, basement room, attic room, etc.

Household Duties:

Cooking             Special Meals             Laundry             Shopping             Pet care   

Cleaning    Approx. square footage of your home

Additional Duties

Elder Care/Disabled:

Name     Age

Describe health condition   

Special Needs/Care:

Name     Age

Describe health condition   

Any additional comment which will be helpful in processing your registration.

How many caregivers have you had in the past three years? 

The review of this registration form is free.  We will contact you within 48 hours upon receiving your registration, either by email or telephone.