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FAMILY APPLICATION FOR
EVENING BABY-SITTING


Mother/Guardian: 
Occupation:    Work Phone:

Father/Guardian: 
Occupation:    Work Phone:

Street Address: 
City:    State:   Zip:
Home Phone:    Cell Phone:
Email: 
How did you hear about Family Helpers? 

CHILDREN'S INFORMATION:

Child 1:
Name:   Sex:   Birth Date: 
Child 2:
Name:   Sex:   Birth Date: 
Child 3:
Name:   Sex:   Birth Date: 
Child 4:
Name:   Sex:   Birth Date: 

Do any family members smoke? Yes No,  Number/type of pets? 

Do any of your children have special needs?

Are there any duties/special requirements related to this position?

Emergency Contact:   Relation:
Contact Phone:   City, State:

SITTER SERVICE AGREEMENT:

Agreement made this day of 2010, between , residing at , , NY hereinafter referred to as "Client" and FAMILY HELPERS, INC., a domestic New York Corporation, 125 Main Street, Dobbs Ferry, New York 10522, hereinafter referred to as "FHI".

Whereas FHI is engaged in the provision of nanny referral and related services and

Whereas Client is desirous of utilizing certain of those services, the parties agree as follows:

1. Payment to FHI for the service shall be $100.00 payable in advance for a six (6) month period and $15 per occasion of baby-sitting. Baby-sitters (Helpers) are paid hourly, and the hourly rate is based on the number of children. The hourly rate may be increased for child(ren) with special needs.

2. Clients make baby-sitting requests by emailing or phoning Family Helpers. There is a four hour minimum per evening/occasion of baby-sitting. For holiday requests, or if requests are made less than 48 hours in advance, the agency fee is $25. If a client cancels an evening of baby-sitting that has already been scheduled, the client is obligated to pay the Helper one half of her normal rate if the job is canceled less than 24 hours in advance. If the baby-sitting job is canceled more than 24 (business) hours in advance there is no fee it due to the Helper. In either case FHI will charge the client the agency scheduling fee.

For families who have swimming pools, children should not be allowed to swim if the Helper is alone with the children. Also, unless a Helper works regularly for the same family, Helpers should not be asked to bathe the children.

3. Client agrees to hold harmless and indemnify FHI for any claims by or against Helper or Client related to Client's use of said baby-sitters.

4. Client acknowledges that the names, addresses and phone numbers of its Helpers are proprietary information of FHI. Client agrees not to disclose or disseminate the information of said Helpers to any other party.

5. Client further acknowledges that if Client disclosed or disseminated any of the information regarding Helpers, that FHI would be irreparably harmed and the harm to FHI would be difficult to determine. Therefore Client agrees that if Client should disclose or disseminate any such information Client will pay to FHI upon written demand by FHI the sum of $2,000.00 as liquidated damages. Client shall also be liable for reasonable attorney fees and other costs of collection.

6. Client agrees that Client is provided with the names of Helpers for the sole purpose of occasional baby-sitting. Client agrees that it shall not solicit the services of a Helper for any other purpose, nor shall Client attempt to interfere with any current employment arrangements related to FHI placements or other services.

7. Client shall refrain from making any private agreement with the Helper or from taking any action which is inconsistent with this agreement or any other FHI agreement to which Client is a party or which has the effect of avoiding any of the Client's obligations hereunder. Such private agreements and actions include, but are not limited to, actions which would enable the Client or any other person to avoid payment of the registration and/or list fee or placement or referral fees due to FHI, as for example, if Client gave the name of the Helper to another person who subsequently employs the Helper or a friend of the Helper.

Client agrees not to employ any Helper referred by FHI for two year's time after the expiration of this agreement. Client agrees not to disclose to anyone the names or addresses or telephone numbers or any Helper referred to the Client. If Client violates any of the provisions of this paragraph, Client shall be liable for liquidated damages in accordance with paragraph 4 of this agreement.

8. This agreement contains the entire understanding between the parties and may not be changed or modified except in writing signed by both parties, and shall be governed by the laws of the State of New York.

IN WITNESS WHEREOF, the parties have executed this Agreement by clicking on the SUBMIT key. Clicking the SUBMIT key is equivalent to signing the document

Please enter the date of this agreement:

Please provide us with a credit card number. The agency fee will be charged directly to the client credit card. The client is responsible for paying the baby-sitter (employee) at the end of the day/evening of baby-sitting.

Credit Card Information:
Name on Credit Card:
Credit Card Type:
Credit Card Number:
Expiration Date (mm/yy):
Security Code:

     


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