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First name

Last name

Address

Phone Number (Whatsapp Preferred)

Email

Which Service are you booking?

If you selected Companion care, tell us more about what you require.

Requirements for All other services

(NOT FOR COMPANION OR MOBILITY CARE)

Preferred Care Giver Type

Date

Start Time

Time

HoursMinutes

Estimated End Time

Time

HoursMinutes

Names and Ages of Children Requiring Care

How many children?

If you require care for 4 or more children, Please give details.

This service will require additional staff members.This is depending on the clients needs.

Child Interests (activities they like)

Allergies (Food, Medication, Environmental)

Medical or Behavioral Notes

Is caregiver allowed to take children outside the room?

Yes, around hotel grounds.

No

Ask me first

Yes, at family residence

How many adults/elders need care? (If Applicable)

Requiring care for 3 or more will require additional staff members. This is depending on the clients needs

Name, Age, and Primary Condition of adult or elder. (If Applicable)

Current Medications (if any)

Emergency Contact Name & Phone

Special Instructions or Requests

Tell our team how we can serve you and your family best.

I agree to the Paradise Nannies Policies & Terms.

I confirm all information provided is accurate.