Parent Information

Our Privacy Policy is simply not to share any information of yours with anyone under any circumstances. Caring, complete professionalism and confidentiality is our policy, under several versions of law, but mostly because of our commitment to you.

Parent Information

Last Name:  

Mother's Name: Work #: 

Occupation: Cell?:

Father's Name: Work #: 

Occupation: Cell?:

Home Phone #:    FAX?: 

Child/Children Information

Child #1

Name: DOB: Sex:

School Attending:

Hours of School: 

Child #2

Name: DOB: Sex:

School Attending:

Hours of School: 

Child #3

Name: DOB: Sex:

School Attending:

Hours of School: 

Child #4

Name: DOB: Sex:

School Attending:

Hours of School: 

Child #5

Name: DOB: Sex:

School Attending:

Hours of School: 

Are all children listed above members of the same immediate family?

YES  NO

(If more than 5, please use notes field or call)

HOME

Address: Apt:

City: State: Zip Code:

Your Email Address: 

Type of Services You MAY Need? (Hold down Control Key to make multiple selections)

Meals     House Sitting/Chores     Appointments

Household Duties     Incontinence     Pet Care     Other

(If you check OTHER, please explain in "notes box" below.)

Will you reimburse the Care Provider $.35 cents per mile for expenses if using their own vehicle for your family business purposes? YES  NO

Please check if you have any of the following:

DOG(s)   CAT(s) Other  >

In the box below, Please provide us with explicit directions to your home using landmarks and mileages for our records so we may better serve you.

How did you hear about us?

 Web   Client Referred You  Newspaper

  Radio Television Commercial Other

If a satisfied and well cared for Client of ours referred you, please tell us so we can send them a thank you card.

Referred by:

Thank You very much for registering. This enables us to have pre-matched your needs to the best Providers we have and indicate that in your file. So, when you call or request service online or by phone, we can serve you better and provide you with all of the benefits that come from being part of  The Family Tree. 

We appreciate your business and care for your loved ones.

Would you like to receive our newsletter? (Check)

If you have any comments you wish to add, please do so in the box below and then read the agreement and click the button to submit form. Thank You.

Agreement

Upon the filing of my profile and receipt of my annual enrollment fee, I fully understand and accept that The Family Tree Care Services is a company in the business of recruiting and registering quality child/elder care providers for families to hire by the day, week, or on a permanent basis. I know and understand that all requests/placements must be made through The Family Tree Services office and not on an individual basis. It is to my advantage to inform The Family Tree Care Services of my needs as soon as possible, to ensure the hours and the sitter I am requesting. If my family has special needs (such as transportation, chicken pox, incontinence, etcetera) I will inform the service at the time of the request.

I understand if I hire a Family Tree provider on a temporary basis, that the provider is an independent agent of The Family Tree. The provider is responsible for his/her own actions and for the payment of any and every tax incurred while in my employment as per their contract with The Family Tree Care Services.

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 Please type your FULL NAME below to constitute an electronic signature, indicating you have read and agree to the above terms of service.

Note: it takes 24 hours to process online registrations.