Tell us a little about your household and the care you’re looking for. Select your services to see the relevant questions. All questions shown are required.

Family Intake Form

Tell us a little about your household and the care you’re looking for so we can get to know your family before your consultation.

First Name

Last Name

What type of care or household support are you looking for? Select all that apply.

About Our Family

Introduce your family in a short paragraph. Tell us about your hobbies, what you enjoy doing together, and any likes or dislikes that are part of everyday life.

Your Family Introduction

Which parenting styles or approaches describe your family? Select all that apply.

Traditional

Strict

Montessori

Positive Discipline

How many children are you including in this intake? Count any baby you’re expecting.

None

3 or more

Are there pets in your home?

Yes

Pay Rate or Range

Choose a pay rate or range for each service shown. We’ll discuss pay for combined roles during your consultation.

Which provider will you use for W-2 payroll?

HomeWork Solutions

Poppins Payroll

GTM

About Our Schedule

Please include all three details in your answer.

1. Your ideal start date and how flexible it is.

2. The days you need care and the start and end time for each day.

3. Any schedule changes during school breaks, holidays, or summer. If your schedule stays the same, say so.

What is your requested care schedule?

Benefits

Part-time and full-time employees receive benefits.

Which benefits will you offer your employee? Select all that apply.

Tell us a little about your household and the care you’re looking for. Select your services to see the relevant questions. All questions shown are required.

Family Intake Form

Tell us a little about your household and the care you’re looking for so we can get to know your family before your consultation.

First Name

Last Name

What type of care or household support are you looking for? Select all that apply.

About Our Family

Introduce your family in a short paragraph. Tell us about your hobbies, what you enjoy doing together, and any likes or dislikes that are part of everyday life.

Your Family Introduction

Which parenting styles or approaches describe your family? Select all that apply.

Traditional

Strict

Montessori

Positive Discipline

How many children are you including in this intake? Count any baby you’re expecting.

None

3 or more

Are there pets in your home?

Yes

Pay Rate or Range

Choose a pay rate or range for each service shown. We’ll discuss pay for combined roles during your consultation.

Which provider will you use for W-2 payroll?

HomeWork Solutions

Poppins Payroll

GTM

About Our Schedule

Please include all three details in your answer.

1. Your ideal start date and how flexible it is.

2. The days you need care and the start and end time for each day.

3. Any schedule changes during school breaks, holidays, or summer. If your schedule stays the same, say so.

What is your requested care schedule?

Benefits

Part-time and full-time employees receive benefits.

Which benefits will you offer your employee? Select all that apply.

Family Intake Form

Contact Information

Services

About Our Family

About Our Children

About Our Pets

Pay Rate or Range

About Our Schedule

Benefits

Family Intake Form

Contact Information

Services

About Our Family

About Our Children

About Our Pets

Pay Rate or Range

About Our Schedule

Benefits