Register with Choice Options Registering with Choice Options is free and there is no obligation. Register First Client’s Information Name * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Optionally, please provide your gate or garage code, if any Email * Cell Phone * Work Phone Additional Phone Place of Employment Second Client’s Information Name Name First First Last Last Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Optionally, please provide your gate or garage code, if any Email Cell Phone Work Phone Additional Phone Place of Employment Emergency Contact Information Name Name First First Last Last Relationship to Client Emergency Contact Phone Services you may use (you can always change this later) Nannies Adult Companion Hotel Care Domestic Management House Sitting Pet Sitting Children Do you have children? Yes No How many children would you like to include with your registration? 12345 First Child Child’s Name * Child's Name First First Last Last Gender * Female Male Date of Birth * Child’s Age * Does this child have special needs? * Yes No Please explain your child’s special needs Please provide other pertinent information about this child, if any Second Child Child’s Name * Child's Name First First Last Last Gender * Female Male Date of Birth * Child’s Age * Does this child have special needs? * Yes No Please explain your child’s special needs Please provide other pertinent information about this child, if any Third Child Child’s Name * Child's Name First First Last Last Gender * Female Male Date of Birth * Child’s Age * Does this child have special needs? * Yes No Please explain your child’s special needs Please provide other pertinent information about this child, if any Fourth Child Child’s Name * Child's Name First First Last Last Gender * Female Male Date of Birth * Child’s Age * Does this child have special needs? * Yes No Please explain your child’s special needs Please provide other pertinent information about this child, if any Fifth Child Child’s Name * Child's Name First First Last Last Gender * Female Male Date of Birth * Child’s Age * Does this child have special needs? * Yes No Please explain your child’s special needs Please provide other pertinent information about this child, if any Pool Do you have a pool? Yes No Is your pool fenced? Yes No Pets Do you have any pets? Yes No What type of pets do you have? Terms and Conditions Please indicate your agreement with the terms and conditions by checking each box and then signing below All Choice Options caregiver wages are the responsibility of the client. All Choice Options caregivers are independent contractors and are to be paid directly by the client at the end of each job. Agency fees paid in advance are non-refundable. Charges over $300.00 will include a 5% fee. Cancellations with less than 12 hours notice will result in a $45 agency fee and caregiver will be paid for all scheduled hours. If scheduled hours are decreased (upon or after the start time), caregiver will be paid for anticipated scheduled hours. If scheduled hours are increased (upon or after the start time), caregiver will be paid for additional scheduled hours. Cancellations with less than 48 hours notice will result in a $45 agency fee, regardless of staffing status. If we, the agency, cannot fulfill the client’s needs, there are no fees applied. Services are to be requested through Choice Options ONLY. Client shall not contact any Choice Options caregiver directly during working or non-working hours regarding scheduling. Choice Options is accessible 24/7/365 and is always able to provide assistance as needed. Client shall not hire for client’s family or refer to another family a Choice Options’ caregiver for any type of work without Choice Options’ prior knowledge. If so, client shall be immediately responsible to pay Choice Options an amount equal to twice the permanent placement fee (25-30% of the nanny/caregiver’s annual salary), plus attorney and legal fees, if applicable. Registration with Choice Options is free. You must register to use the services offered by Choice Options. I have read and agree with the Terms and Conditions, and that I want to register with Choice Options (type your name below) * How Did You Hear About Choice Options? Web SearchSocial MediaRadio/TVReferralOther Who can we thank for the referral? If other, can you tell us some more? Please add any other pertinent information Submit If you are human, leave this field blank.
