Flex Family Profile Please RE-ENTER Main Contact Email:* This should be the same email that your initial registration form. Your Family Care GuideThis information will be used to create your Family Care Guide, a tool we share with our team so that our nannies and sitters can provide personalized care. We will find out more about your children further down the form. Routine(For example: meals/snack times, nap or bedtimes, school pick-up times, etc.) Please list your household rules.What are your nutritional preferences?Nannies will use this information to plan and prepare meals for your children.How would you like a nanny to approach behavioral modification while in your home?General Household InformationTell us more about your household. Parent 1 Name* First Last Parent 1 Phone*Parent 2 Name First Last Parent 2 PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Does anyone in your family smoke?* Yes No Do you have unsecured weapons or other firearms in your home?* Yes No If yes, please explain.Do you have a security or survellience system in your home?* Yes No If yes, please explain.Do you have a pool, fountain or other permanent body of water at your residence? Yes No If yes, please explain.Has anyone in your home ever been arrested or convicted for any offense other than a minor traffic violation?* Yes No If yes, please explain.Have there been any incidents of domestic violence in your family that were reported to the police or social service agencies?* Yes No If yes, please explain.ChildrenHow many children under the age of 18 are in your household?*0One (or more!) on the way,123456+Child 1 Name: First Last Sex: Male Female DOB MM slash DD slash YYYY Please list any allergies, medical conditions or special needs.School & Address Grade Level: Please list your child's activities, interests and hobbies.Child 2 Name: First Last Sex: Male Female DOB MM slash DD slash YYYY Please list any allergies, medical conditions or special needs.School & Address Grade Level: Please list your child's activities, interests and hobbies.Child 3 Name: First Last Sex: Male Female DOB MM slash DD slash YYYY Please list any allergies, medical conditions or special needs.School & Address Grade Level: Please list your child's activities, interests and hobbies.Child 4 Name: First Last Sex: Male Female DOB MM slash DD slash YYYY Please list any allergies, medical conditions or special needs.School & Address Grade Level: Please list your child's activities, interests and hobbies.Child 5 Name: First Last Sex: Male Female DOB MM slash DD slash YYYY Please list any allergies, medical conditions or special needs.School & Address Grade Level: Please list your child's activities, interests and hobbies.Please write any other child-specific care instructions or additional children information here.Due Date: Additional Children Info:Please list information for any additional children here. Please provide any additional information that might help us provide the best possible care for your child(ren).Additional ResidentsDo you have anyone else living in your home including permanent residents and/or extended stay visitors?* Yes No Name: First Last Age: Relationship: Please Check: Permanent Resident Extended Visit Name: First Last Age: Relationship: Please Check: Permanent Resident Extended Visit PetsDo you have any pets?* Yes No Pet Types* Please list ALL pet types in the home. (i.e. cats, dogs, reptiles, etc. If none, enter N/A.)Pet 1 Name: Type: Breed: Care Needs: Please Check: Indoor Outdoor Both Pet 2 Name: Type: Breed: Care Needs: Please Check: Indoor Outdoor Both Pet 3 Name: Type: Breed: Care Needs: Please Check: Indoor Outdoor Both Use this space to provide any other pertinent information about the pets in your household, including information on additional pets not already listed above.In Case of An EmergencyEmergency contacts should be adults other than parents and at least one should be local, if possible.Emergency Contact Name:*This should be someone local, other than the parent(s)/guardian(s)/client(s) already listed. Best Contact Number:* Emergency Contact 2 Name:This should be someone local, other than the parent(s)/guardian(s)/client(s) already listed. Best Contact Number: Pediatrician:* Medication AuthorizationNo medication shall be given by a Trusting Connections employee without written permission of the parent or legal guardian. All prescription medication must be in the original container with the child’s name, name of the physician, medication name, and medication directions written on the label. Trusting Connections Employees may not administer personal medication; only medication provided by the family may be given to the children. Please select ONE of the following three options:OPTION 1: I permit Trusting Connections employees to administer any and all medications necessary, prescription or non-prescription, at the caregivers’ discretion. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I would prefer that the nanny call a parent or guardian before administering medication, if possible. OPTION 2: I permit Trusting Connections employees to ONLY administer the following medications for the reasons specified below. I WOULD LIKE TO SELECT THIS OPTION. Please list any and all medications you would like to authorize AND note under what circumstances the listed medications my may administered. (For example, ".25 ml of Tylenol for pain associated with teething." Please be specific.OPTION 3: I DO NOT permit Trusting Connections employees to administer medication of any kind unless written permission is given to administer medication on the Temporary Authorization form for the day(s) specified. I WOULD LIKE TO SELECT THIS OPTION. Driving AuthorizationWritten permission must be given for a Trusting Connections employee to transport children. The employee is required to observe all safety regulations including seat belt and proper car seat use. If the employee uses her own vehicle for on-the-job driving, she will be reimbursed at the national standard rate. Any mileage charges accrued will be noted on the client’s receipt. Employees are not permitted to install car seats into any vehicle other than their own. If a family vehicle is provided, all car seats must be installed by the client. Verbal consent will not be accepted. Please select ONE of the following three options:OPTION 1: I permit Trusting Connections employees to drive my child(ren) for any childcare-related reason. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I would prefer that the nanny call a parent/guardian before transporting the child(ren), if possible. I would like the nanny to use her own vehicle. I would like the nanny to use the vehicle provided by our family. OPTION 2: I permit Trusting Connections nannies to drive my child(ren) under select circumstances. (You will have the opportunity to specify below.) I WOULD LIKE TO SELECT THIS OPTION. I would like the nanny to use her own vehicle. I would like the nanny to use the vehicle provided by our family. Please explain. List locations the nanny is permitted to transport the children to and from and for what purposes this permission is granted.OPTION 3: I do not permit Trusting Connections nannies to drive my child(ren) for any reason, other than a legitimate emergency, unless written permission is given on the Temporary Authorization form for the day(s) specified. I WOULD LIKE TO SELECT THIS OPTION. Photo Release AuthorizationOur nannies have many special moments with children throughout their careers with our agency and we would love to use/share images captured by our nannies with your permission. Please indicate below if we have permission to use your child’s photograph publicly to promote our agency. The images may be used in print publications, online publications, presentations, websites, and social media. No royalty, fee or other compensation shall become payable to the client by reason of such use. Please know that TC employees are STRICTLY prohibited from taking photos of clients' children without permission. Please indicate your preference below. Please select ONE of the following two options:OPTION 1: I permit Trusting Connections employees to occasionally take photos of my child(ren) for the uses listed above. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I consent as long as the nanny shares the photo with a parent/guardian and seeks approval prior to giving the photo to the agency. I consent as long as my child's face is not directly visible. OPTION 2: I do not permit Trusting Connections employees to take photos of my child(ren) for any reason. I WOULD LIKE TO SELECT THIS OPTION. Release to a Minor AuthorizationSome of our families prefer that our caregivers release the children to an older sibling or younger babysitter at the end of the shift. In order to do this, we need written permission. Please choose one of the following options. Are our caregivers permitted to release the children in their care to another minor, (12 years or older) upon request?* YES, I permit Trusting Connections' caregivers to release my children to a minor if they are instructed to do so. NO, my children may only be released to myself or another authorized adult. Promo Code for Membership Discount Will be applied towards any membership you choose. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.