
Name(s) of employer:  ____________________________________
    ____________________________________
Address:     ____________________________________
    ____________________________________
Name of nanny:    ____________________________________
Address:     ____________________________________
    ____________________________________
Social Security #   ____________________________________
Number of children:    ____________________________________
Names of children:   ____________________________________
    ____________________________________
    ____________________________________
    ____________________________________
Start date:     _________________  
Schedule          
Hours needed on a set, weekly basis and times off:
Monday _________________________
Tuesday _________________________
Wednesday _________________________
Thursday _________________________
Friday   _________________________
Saturday _________________________
Sunday _________________________
Number of sick days:         ______
Number of personal days:  ______
Nanny will give employer  ______ days notice for personal days and 
will call by ______a.m. on the rst day of illness. 
Duties
List the responsibilities you need the nanny to fulll. Being specic in 
this area increases the likelihood there will be less misunderstandings 
and a better satisfaction for both parties. (Ex. Dispensing of 
medication, ongoing playdates, laundry on specic days.)
sample nanny contact
13117 Eastpoint Park Blvd.  
Ste. H
Louisville, KY
(502) 895-9998
(502) 638-2502 fax
After Hours: (502) 541.6441
Owners Kevin and Laura Hall
info@FamilyTreeCareServices.com