ADDENDUM A - Duties and Responsibilities:
ADDENDUM B - Parental Obligations:
Last Updated: Nov 12th, 2023
Update Notes: Reworded "Additional Children" section for clarification. No major changes.
By using my services, you agree to the following terms and conditions:
✷For further explanation, please see the “Notes And Further Explanation” section, after Addendum B.
Meal Obligations: Family will provide meals/snacks for Childcare Provider during working hours. Family will also pay for Childcare Provider’s meals when dining out with children.
Cancellation Policy: The client can cancel anytime prior to 24 hours before the appointment free of charge. If the client cancels within a 24-13 hour time frame of the appointment start time, a cancellation fee of $25 is charged. If the client cancels within a 12-4 hour time frame of the appointment start time, a cancellation fee of $36 is charged. If the client cancels within a 3-0 hour time frame of the appointment start time, a cancellation fee of either $54 OR the scheduled full rate is charged, whichever amount is lower. These charges are only applied if there are no good reasons for a cancellation. A good reason includes a family emergency, sudden illness, injury, nearby crime, illness, act of God, act of terrorism, or other cause beyond the control of the Family. Examples of something not being good reason would be if the Family just doesn’t feel like going on a date night, or something that the family has control over.
✷Overnights: When Family needs Childcare Provider to work overnight due to going out of town or simply needing extra assistance, Childcare Provider will receive an overnight fee of $100 from 10pm until child wakes up in the morning. Hours when the children are awake will be compensated at Childcare Provider’s hourly rate, including applicable overtime. If the children wake during the night, Childcare Provider’s hourly rate will go into effect in addition to the overnight fee.
✷Travel Compensation: When traveling with Family, Childcare Provider will receive their regular weekly guaranteed pay and will be paid for every hour worked, including applicable overtime. Hours spent traveling to and from the destination are legally counted as hours worked. Childcare Provider will also receive a daily ‘per diem’ of $50 for each 24-hour period they are required to be away from home. If Childcare Provider is responsible for the children overnight (i.e. has the monitor in their room), Childcare Provider will receive their overnight rate ($100) instead of the daily per diem. If the children wake during the night, Childcare Provider’s hourly rate will go into effect in addition to their overnight fee. If Childcare Provider is sharing a room with the kids/doesn’t have private accommodations, Childcare Provider will be paid an overnight fee of $100 instead of the daily per diem. All travel-related expenses, including meals, lodging, airfare, and admissions will be covered by the Family.
✷Reimbursement: Family will pay for (in the form of a credit card or petty cash) any and all expenses incurred for mutually agreed upon transportation and childcare activities (including Childcare Provider’s admission costs). If requested, Childcare Provider will provide receipts and invoices for any family money spent. Any expenses over $50 must be pre-approved by Family. If Family does not provide credit card or petty cash, Childcare Provider will not be required to spend more than $20 of their own money per day. If Childcare Provider must pay out of pocket for any job related expenses, Family will reimburse Childcare Provider within 24 hours. If Childcare Provider overdrafts their bank account due to not being reimbursed within 24 hours, Family will pay the overdraft fee. If credit card is provided, Childcare Provider acknowledges that the credit card (“Funds”) provided by the Family are the property of the Family. Childcare Provider agrees to use the Funds only for the purchase of groceries, household supplies, and child expenses consistent with their job duties and for other expenditures expressly authorized by the Family. Childcare Provider agrees not to make any personal purchases with the Funds or to allow any other person to do so. Childcare Provider further agrees to safeguard the Funds and to report any loss or theft of the Funds to the Family immediately.
✷Pet Care: Childcare Provider will assist with caring for family dog during working hours. Duties include letting dog out as needed and making sure water bowl is full. In the event that a new puppy is added to the home and Childcare Provider is expected to care for and clean up after it, Childcare Provider’s hourly rate will increase by $2 per hour until puppy is fully trained and no longer requires such attentive care.
✷Additional Children: In the event that an additional child is added to the family, Childcare Provider will receive a raise of no less than 10%. If Family requires Childcare Provider to provide one time childcare to a relative that is not part of the immediate family, Childcare Provider’s hourly pay will increase by $3 per hour per child. If a friend of the Family needs a babysitter and opts to bring their child over for a playdate/childcare, Childcare Provider will charge that parent their normal hourly rate, unless it is a mutually beneficial arrangement where the Childcare Provider also provides “free” or "discounted" childcare from time to time.
Inclement Weather: Family cannot demand that Childcare Provider drive in unsafe conditions either with or without children. Childcare Provider will make every effort to get to the family home during inclement weather. However, if the city has asked for non-essential vehicles to stay off the road or if one or more parent is not required to go into work, then Childcare Provider will not be required to come in, and will be paid for the day.
✷Late Fee: If Family is late repeatedly or late without notice and Childcare Provider's consent, Childcare Provider reserves the right to charge a late fee of $1/minute after the scheduled end time, instead of their normal hourly rate. This late fee is implemented at the discretion of the Childcare Provider and is intended for habitual tardiness. Childcare Provider agrees to only implement the late fee after having: 1. Previously discussed the issue with Family at a sit down meeting and tardiness continues despite that, and 2. Given Family written notice of the date the late fee policy will go into effect.
✷Mileage: If Childcare Provider is required to use their own vehicle while working, Family will reimburse Childcare Provider at the current IRS Standard Mileage Rate (57.5 cents per mile) at the end of every week separate from their paycheck. Childcare Provider will keep track of mileage and submit it by the end of the month for reimbursement.
✷Backup Care: Family will have backup care options in place for times when Childcare Provider is unable to come into work.
✷Emergencies: Family will provide Childcare Provider with emergency contact information, emergency protocols for health emergencies regarding child or Childcare Provider, and natural disaster/fire protocols. Family will also obtain Childcare Provider’s emergency contact information.
Medication: Childcare Provider will not give any medication to children without parents’ prior authorization unless it is an emergency and in coordinance with EMT or training. This includes over the counter and prescription.
Security Cameras: Family reserves the right to use cameras in their home. The family will not place cameras in private areas such as bathrooms and Childcare Provider’s bedroom in the home (i.e., for overnights). Family will disclose the use of cameras (both audio and video).
Driving Policy: Childcare Provider may not use cell phone in-hand while the vehicle is in motion. This includes, but is not limited to, answering or making phone calls, engaging in phone conversations, reading or responding to emails, instant messages, and text messages. Childcare Provider agrees to use the utmost care and to abide by the law when operating their vehicle or the family vehicle in connection with their employment under this agreement. Childcare Provider agrees to maintain automobile insurance and to refrain from driving in connection with their employment if their auto insurance should lapse. Childcare Provider agrees to inform the Family of any violation of the traffic laws for which they are cited or any collision in which they are involved, whether or not the citation or collision occurs while they are performing their job duties. Violations to this policy will be considered serious and may result in the imposition of discipline up to and including termination.
Vehicle Security: The Childcare Provider maintains a 360-degree camera in their vehicle that records audio and video 24/7. The camera uses AI to detect parking incidents, such as break-ins, collisions, bumps, accidents, and scratches until the camera battery dies, and also uses AI during drives to detect hard brakes, extreme acceleration, sharp cornering, collisions, forward collision warnings, and other custom events. The camera records in a cycle and records over old files unless the card is removed. This is for the purpose of ensuring the safety of the children, Childcare Provider, vehicle, and anything in the vehicle. The Provider will notify the family if they remove the card and provide a reason. The family may request the card be removed to view the files in the presence of the Childcare Provider or to have the files sent to them. The family understands that the camera is designed to record over old files, so old files will be deleted and unretrievable. The family must request the files within 24 hours of the recorded date. Failing to do so risks the footage being automatically deleted and thus unretrievable.
Social Media: Childcare Provider understands that no information about their location, plans for the day, or pictures of the children should be shared on any social media network without prior approval from Family. Childcare Provider will also not tell strangers to the Family where they are spending the day, unless Family has authorized Childcare Provider to provide such information.
Confidentiality: Childcare Provider understands that any and all private information obtained about Family or their dependents during the course of employment, including but not limited to medical, financial, legal, and professional information, are strictly confidential and may not be disclosed to any third party for any reason. In return, Family understands that any and all private information obtained about Childcare Provider or their dependents during the course of employment, including but not limited to medical, financial, legal, and professional information, are strictly confidential and may not be disclosed to any third party for any reason.
Defamation Clause: Childcare Provider agrees not to attack/criticize employers with identifying information through oral or written word on public forums, blogs, social networks or any other platform at any time during or subsequent to contract period. Family agrees not to attack/criticize Childcare Provider with identifying information through oral or written word on public forums, blogs, social networks, or any other platform at any time during or subsequent to contract period.
Termination: If either party wishes to terminate employment without cause, they must give 3 day’s notice and Family must pay out all accrued vacation time. If Family fails to give 3 day’s notice for termination without cause, Family must give equivalent severance. Termination with cause may be immediate. If Family terminates Childcare Provider with cause, they are not required to pay out vacation time or severance. If Childcare Provider gives notice and Family chooses not to have Childcare Provider work their entire notice period, Family will pay equivalent or prorated severance. Reasons Family may terminate Childcare Provider with cause: violates this agreement in any way, misses a day of work without notifying the Family, is repeatedly late to work, lies, steals or is otherwise dishonest to the Family, is convicted of a crime, crosses professional boundaries with Family, drinks alcohol while working, uses illegal drugs at anytime, fails to perform job duties or allows children’s safety to be compromised in any way. Childcare Provider may quit with cause for the following reasons: Family violates this agreement in any way, Family does not pay Childcare Provider in a timely manner, Family lies, steals, or is dishonest to Childcare Provider, an immediate member of the Family is convicted of a crime or does illegal drugs, or if Childcare Provider’s safety and/or personal boundaries are compromised while at work.
Duties and Responsibilities
NOTES AND FURTHER EXPLANATION
The information provided in these notes and explanations are from nannycouncil.com to further explain the sections included in the agreement.
✷Work Hours: While not legally required, offering guaranteed hours is the industry standard for childcare providers. Guaranteed hours means your Childcare Provider will have consistent income each week, and ensures they will keep their scheduled hours open for your family. They are reserving these hours for you each week (even if only part-time) and cannot simply pick up another job if you don’t need them for a day or a week when you travel. If you do not need your Childcare Provider to work, it’s not fair to tell them to not come in and then not compensate them. If you do not need your Childcare Provider for the full number of scheduled hours in a week and they are willing and able to work, the proper thing to do is to compensate them for their full number of guaranteed hours. Think of it as paying to reserve your Childcare Provider’s time and ensuring your Childcare Provider will not find a new job while you are away. Some parents will let their Childcare Provider go home early from time to time or have a random day off on occasion, if they happen to be home (or grandparents are visiting) and don’t really need the Childcare Provider to be there. This is not to suggest that a Childcare Provider should automatically always get to go home early if you get home early/stay home from work, but keep it in mind if you are able to “surprise” your Childcare Provider with this from time to time. Childcare providers work long hours, so getting off a little early every once in a while really means a lot to a Childcare Provider and helps reduce burnout. Also, it is illegal to ask your Childcare Provider to “bank” hours, which is where unused hours from one pay period are fulfilled in another pay period (a pay period is defined as 7 days, per the FLSA).
✷Regular Pay: It is illegal to not pay an overtime rate of time and a half on anything over 40 hours in a 7-day period. Per the FLSA, Childcare Providers are nonexempt hourly employees and cannot be paid a true salary. A Childcare Provider can report a family to the Department of Labor and sue for unpaid overtime, so it’s not worth the risk. A late fee is added in here because for many Childcare Providers, late payment can become an issue. Just like you, your Childcare Provider budgets and relies on getting paid on time. This is why using a payroll service is highly recommended. When using a Childcare Provider payroll service, parents never have to remember to take out cash or write their Childcare Provider a check or give their Childcare Provider a pay stub. It’s important for a Childcare Provider to receive a pay stub each pay period, because this is their proof of income. Regular pay stubs allow a Childcare Provider to apply for an apartment lease, purchase a car, etc. It is up to you and your Childcare Provider to determine which method and how often they are paid.
✷Overnights: This is because getting paid hourly for all overnight hours would add up quickly, however, the Childcare Provider is still responsible for the children during this time and must be compensated accordingly. A Childcare Provider is not free to leave the home once the kids are asleep, so they are still working. Overnight fees range from $75-$200+ per night or other Childcare Providers may charge half their hourly rate during overnight sleeping hours. However, for infants, most Childcare Providers charge their full hourly rate overnight because infants do not sleep through the night. The reason the flat overnight rate starts at 10pm vs when the children go to bed, is because the Childcare Provider likely has to clean up after the kids go to to bed, prep things for the next day, etc. Furthermore, if a Childcare Provider were working a date night, they would be compensated at their hourly rate until the parents get home, which is usually around 10/11pm. Since a Childcare Provider is giving up their night and unable to be with friends/family, they should be compensated at their hourly rate until they are likely to go to bed (10pm), and then compensated at their overnight rate during sleeping hours. Sometimes parents are shocked at how expensive it is to hire a Childcare Provider to work an overnight, but it’s important to keep in mind that you are asking someone to work 24 hours a day for however many days you are away — it’s very demanding and simply very expensive to have someone work that many hours and be away from their own home, friends/family, pets, et cetera, in order to provide private care for your children around the clock.
✷Travel Compensation: Childcare Providers often charge a travel ‘per diem’ ranging from $25-$100/day. This is sometimes referred to as an “inconvenience fee” because the Childcare Provider is unable to be in the comfort of their own home, with access to their own vehicle, and may have to pay for a pet sitter while they are away. If a Childcare Provider is expected to share a room with the kids, and therefore have no privacy and no space to relax and recharge (i.e., watching some tv in bed before falling asleep or talking on the phone to a loved one before bed, etc.) then the Childcare Provider must be compensated very well, which is why this overnight fee is much higher. Some Childcare Providers charge their full hourly rate 24/7 including applicable overtime, when expected to share a room with the children because with no privacy, it is like the Childcare Provider is working constantly. Keep in mind that some Childcare Providers will not travel unless they have private accommodations, so if you plan to have your Childcare Provider share a room, it’s important to first ask them if they are open to it. Family is responsible to cover meals even when Childcare Provider is off the clock because this is an expense they would not incur if not on a work trip with your family. It’s important to remember that your vacation, is not your Childcare Provider’s vacation. This is a business trip for your Childcare Provider, therefore they must be paid accordingly. Most Childcare Providers report working longer and/or harder hours when traveling with their Childcare Provider family and if it’s a long trip, having to jump right back into their normal workweek upon return. Sometimes this means a Childcare Provider will have worked for 10+ days straight. Parents need to remember that even if they get back from the trip and have to jump right back into work the next day, they are coming back from a relaxing family vacation. Your Childcare Provider is not coming back from a relaxing vacation, but rather a very demanding business trip. Upon returning from a 5+ day trip, offering your Childcare Provider a paid day or two off helps reduce Childcare Provider burnout and lets your Childcare Provider know that you understand they are human and deserve a day or two to recharge.)
✷Reimbursement: If Family requests that Childcare Provider dine out with the children, their meal must be covered by Family. Many families also allow their Childcare Provider to eat out with the children or grab a snack while out at their discretion and cover these costs. It is a good idea to discuss how often is appropriate and practical for your Family. Additionally, some Families give their Childcare Provider a weekly (or monthly) amount that they can spend on activities, outings, meals out, etc. with the children and then approve larger outings on a case by case basis. While it’s not required to give your Childcare Provider a credit card or petty cash, it is highly recommended. It is unfair to expect your Childcare Provider to front the money for job-related expenses. If a Childcare Provider must pay for something with their own money, it is very important they are reimbursed in a timely manner. Oftentimes Childcare Providers are not reimbursed quickly, and they feel uncomfortable bringing this issue up, especially if they need a timely reimbursement due to personal financial reasons. If a Childcare Provider is required to use their own money, they should be the one to determine how much they can afford to spend per day, as notated in this agreement. Again, many Childcare Providers will not feel comfortable discussing this because it’s embarrassing if they are tight on money, so it is highly recommended to never force your Childcare Provider to use their own money.)
✷Pet Care: Pets are members of the family and most Childcare Providers are okay helping out with basic pet care. This does not include cleaning pet crates/cages or any sort of cleaning/washing related to pets. This also does not include taking dogs on long walks or pet sitting overnight. Letting a dog out back in a fenced yard is a task most Childcare Providers are happy to help with, but dog walkers/pet sitters charge good money and many Childcare Providers are dog walkers/pet sitters on the side for extra income. It’s unfair to expect your Childcare Provider to double as your dog walker/pet sitter, without increasing their pay. If you’d like to hire your Childcare Provider as your dog walker or pet sitter because it’s easier than hiring a separate person, see if they are open to it and make sure to compensate them what you would if you hired a separate person to come to your home. Also, if you are adding a puppy to your family and need your Childcare Provider to take on the task of caring for the puppy all day, your Childcare Provider should be given a raise of at minimum, $2/hour. Puppies are incredibly hard work and many Childcare Providers can become resentful if a puppy is added to their workload without proper compensation. Adding $2-$3 per hour to your Childcare Provider’s pay is significantly cheaper than hiring a separate person to care for, train, and clean up after your puppy all day. Some Childcare Providers may not like pets or may be allergic to them, so it’s important to discuss your needs and expectations with your Childcare Provider.)
✷Additional Children: An example of this would be when two sets of parents want to have child-free time together and need the Childcare Provider to provide care for both families’ children, or another child from school needs to come over every Wednesday until their parents can pick them up. The above examples are when a Childcare Provider would charge each family their full hourly rate. Many Childcare Providers are flexible and don’t mind pitching in if a close family friend is in a pinch and needs a few hours of care for their child, especially if it is a give-and-take situation where the Childcare Provider receives the same help when they are in a pinch and needs a few hours to get stuff done. Additionally, most Childcare Providers do not consider a playdate to count as childcare for an additional child, however, playdates should be run past the Childcare Provider before scheduling.)
✷Late Fee: Late fees vary and are implemented at the discretion of the Childcare Provider. This is not meant to penalize a parent who is late every once in a while, this is to prevent habitual tardiness. If your Childcare Provider is repeatedly late to work, it is likely they will lose their job. There is not as much on the line for parents when it comes to being punctual, so unfortunately, many Childcare Providers are taken advantage of by habitually late parents, even if only by 10-15 minutes. Your Childcare Provider makes sure to show up on time every day, so you should show them the same courtesy. Your Childcare Provider relies on getting off at a certain time and plans their life accordingly, so it’s important their time is respected. Please keep in mind that your Childcare Provider’s end time is when they should be walking out the door. If you plan to chat with your Childcare Provider about how the day went and want to go over things to ensure a smooth transition, it is recommended to arrive home between 5-15 minutes before your Childcare Provider’s scheduled end time. Some families may require their Childcare Provider to have flexible hours because they have jobs with unpredictable hours or they simply pay their Childcare Provider very well for their flexibility. In these cases, it is up to the family and the Childcare Provider to decide if and how to implement a late fee.)
✷Mileage: In some states parents are legally obligated to reimburse mileage, so it’s important to check your specific state laws. With that said, even in states where it’s not a legal requirement, it is the industry standard and Childcare Providers should be reimbursed mileage for any job related drives (mileage reimbursement is not income, therefore it is not taxable). It’s important to reimburse using the current IRS rate, instead of just offering a flat rate to cover gas. It’s not just gas that needs to be accounted for, it’s the wear and tear on the vehicle, so that is why the IRS rate is used. Even driving just 5 miles per day adds up ($708.50 per year!), so please do not dismiss reimbursing mileage. if your Childcare Provider does not drive very much. Please also do not take away other benefits because you reimburse mileage. It’s important to remember that mileage reimbursement is not considered a benefit, it is simply reimbursement. It costs your Childcare Provider a lot of money to use their car for work (gas, insurance, car payment, more frequent oil changes, needing new tires more often, etc.) so the fair thing to do is to reimburse them at the full IRS rate. This is not something to nickel and dime and cut corners on. Yes, it adds up and is costly, but to have an employee use their personal car for work, it is going to cost a decent amount of money. Many parents find that for a little bit more than it costs to reimburse mileage, they can purchase an inexpensive Childcare Provider car. This way parents do not have to worry about tracking and reimbursing mileage. Another perk to providing a Childcare Provider car is parents then know for sure the car is in good working condition and safe. For example, when a Childcare Provider uses their own car, parents have no way of knowing that the Childcare Provider will get new tires when needed. A Childcare Provider might put off getting new tires for a little bit, and could be driving the kids around on tires the parents deem unsafe. With a Childcare Provider car, you know everything is up to your standards and your kids are in a car that is well maintained. Many parents opt to purchase a used minivan and find that the monthly car payment and insurance costs, are close to the cost of mileage reimbursement —
especially if the Childcare Provider is required to do a lot of driving. Most Childcare Providers prefer a Childcare Provider car because it’s a big sacrifice to use their own car to transport children. Childcare Providers who use their own car have to pretty much always have car seats in the back of their car even during their off hours. Their car gets dirty quicker because of sippy cups, snacks, kids kicking the back of the seat, fingerprints on the windows, etc. Lastly, parents who have a Childcare Provider car then also have a designated kid car for themselves to use when their Childcare Provider is off. This means parents can keep their personal cars clean and kid free, and only have to worry about one car being heavily worn and depreciated by children.
✷Backup Care: It is so important to have backup care in place — and not just one backup care option. Whether it’s relatives you can call in a pinch, or a pool of babysitters — backup care is a necessity. Childcare Providers hate to miss work, as they know how much it inconveniences the family. When parents don’t have backup care, it can often lead to a Childcare Provider feeling frustrated. This is because lack of backup care results in a Childcare Provider feeling guilty for something they shouldn’t feel guilty for. Childcare Providers will miss work from time to time, sometimes unexpectedly (life happens!), and it is the parents’ responsibility to have multiple backup care options in place.)
✷Emergencies: A notarized medical release form is not required but strongly suggested.
Confidentiality is required in child care programs to protect the rights of children and families. I will not talk about or share written information, pictures, or any other identifying information about a child or family without the written permission of the family. When information is shared it is based on a need-to-know and is done with the written permission of the family to support decision-making and planning.
I am committed to protecting and upholding the rights and privacy of children and their families. All children will be treated fairly, in a non-discriminatory way, regardless of racial, ethnic, gender, cultural, religious and linguistic background and abilities. All information pertaining to children and their families is maintained in a confidential manner to ensure their privacy is protected. Confidential and private information will be disclosed only with parental consent and only when there is an established "need to know‟. Your child’s information is kept in their confidential file and is available for your review upon request. If you do wish to share your child’s information with other professionals, you will be required to sign a release of information.
It is my intention to respect the privacy of children and their parents and carers, while ensuring that they access high quality care and education.
I aim to ensure that all parents and carers can share their information in the confidence that it will only be used to enhance the welfare of their children.
I keep two kinds of records on children in my care:
1. Developmental records
2. Personal records
Access to personal records
Parents may request access to any records held on their child and family following the procedure below.
All the undertakings above are subject to my commitment, which is to the safety and well being of the child. Please see also our policy on child protection.
The purpose of this Child Protection Policy is to provide a framework that aims to protect children and reduce the risk of child abuse or exploitation.
I agree to:
“It is a child’s right to have privacy, and they should be protected from attacks against their life, family, good name, and homes.”
1. The following guidelines help set clear procedures when photographing, filming, or publicly sharing information about a child
2. I will:
As a childcare provider, I understand that I have a legal and moral responsibility to ensure the safety and well-being of the children in my care. One of the most important aspects of this responsibility is being a mandated reporter under the laws of Virginia. As a mandated reporter, I am required by law to report any suspected child abuse or neglect to the appropriate authorities.
I take my role as a mandated reporter very seriously. I understand that I am in a unique position to identify and report suspected abuse or neglect, and I recognize that my actions can have a significant impact on the lives of the children in my care. I am committed to doing everything in my power to protect the children in my care and to ensure that they receive the help and support they need.
I understand that being a mandated reporter is not optional. It is a legal requirement that carries with it significant consequences for failure to comply. If I fail to report suspected abuse or neglect, I could face criminal and civil liability, as well as the revocation of my childcare certifications.
When reporting suspected abuse or neglect, I understand that it is important to follow the proper procedures. In most cases, I will be required to make a report to the Department of Social Services or law enforcement agencies. I am prepared to provide as much information as possible, including the names and ages of the children involved, the nature of the suspected abuse or neglect, and any other relevant details.
I understand that my report is anonymous and confidential. Neither the reported account nor the child will be notified. However, I still feel it is important to talk to the child about any concerns I have and encourage them to report any accounts they think are breaking the rules.
In conclusion, being a mandated reporter is a serious responsibility that requires my full attention and dedication. I am an important part of the network of professionals who work to protect children from harm, and my actions can have a significant impact on their lives. I am committed to taking my role as a mandated reporter seriously, and to always acting in the best interests of the children in my care.
If you are onboarding and have not filled out your preferences yet, please do so here.
Childcare Information Form
* = Required
General required questions so I know exactly what I'm doing
1. What's your (adults/guardians) name(s)?*
2. What's your phone number(s)?*
3. What's your home address?*
4. If I need to reach you:*
Mark only one oval.
Health and Safety
5. Allergies or Medical Issues*
Include dosages and times for medications
6. Location of emergency items*
Bandages, Benedryl, Epipen, First aid kit, etc.
7. Children's Doctor's Name
8. Children's Doctor's Phone Number
9. Children's Doctor's Address
10. Please Use:
Check all that apply.
11. Are there any religious or cultural matters I should be aware of?*
12. At what point should I contact you if a disciplinary issue arises?*
13. If there's an emergency, would you like me to contact you first or call 911 first?*
Mark only one oval.
Contact me first
Call 911 first
14. What resources and contacts do you have if there is an emergency?*
Please provide a trusted friend or family member (and their name/relation) I can contact in case I can't reach you.
Most of this section is optional, it just helps me with what your child likes to do, and if they have any responsibilities that need to be fulfilled.
15. How many children do you have?*
Mark only one oval.
16. What are their name(s), birthday(s) [mm-dd-yyyy], and preferred gender(s)?*
If your children are LGBTQ+ or go by a different gender than their birth-assigned gender, please write that here.
House & Rules
17. What types of music (artists or specific songs) do your kids like?
I create separate playlists for different families on Spotify so when I drive the kids, we'll listen to what they enjoy listening to! I might also put in some songs that are similar to their tastes that they might like :) I can share a collaborative Spotify playlist and you can add songs if you'd like, just mention it in your answer!
18. Rules on photos of kids*
Some parents like me to send photos of what we're up to when I'm taking care of their kiddos, some like me to create an Google Photos album that adds photos of their kids automatically, some parents have kids that are really into photoshoots, and some parents prefer no photos! Just let me know what floats your boat and I can provide accordingly. These photos are never shared with anyone else without your consent.
Check all that apply.
No photos, please!
Yes photos, send them as you take them!
Yes photos, would prefer an automatic album (reduces spam messages)
Yes photos, my kids also like photoshoots!
19. Top house rules
No shoes in the house? Pets stay inside?
Restrictions on programming or time?
21. Wi-Fi password
22. Personal cell phone policy
Check all that apply.
Only to communicate with our family
Limit to emergencies
OK if child is sleeping
Occasional usage is fine
23. House phone policy
Mark only one oval.
Answer and take message
Let voicemail get it
No home phone
24. Alarm Code
Example: 8:30 AM
Example: 8:30 AM
Example: 8:30 AM
Example: 8:30 AM
Example: 8:30 AM
30. Favorite Foods
Foods to avoid (not allergic - only if on diet)
If it's an allergy, please put that in section 1!
Naps & Bedtime
32. Nap #1
Example: 8:30 AM
33. Nap #2
Example: 8:30 AM
Example: 8:30 AM
35. Bedtime Routine
36. In the crib/bed:
Mark only one oval.
Stuffed animal ok
Fun & Favorites
37. Favorite toys, games, and activities
38. What does your family like to do for fun?
39. What strengths do your children have?
40. What challenges do your children have, and how should I work with them?
41. special notes
We're at the home stretch here! Just some general questions regarding my responsibilities.
42. What do you expect of me?
Will I cook meals? Do housework? Wash clothes? Provide homework help?
43. Any other information that I should know?
44. Do you have any questions for me?
45. Will I be providing child transportation?*
This just adds a quick agreement regarding car and passenger security.
Mark only one oval.
1. Policy Statement
2. Purpose and Scope
4. Dash Cam Footage
7. Monitoring and Review
1. POLICY STATEMENT
This policy sets out the position of Maxwell Mandell on the use of on-board incident capture devices (Dash Cams) in vehicles and its effect on passengers.
2. PURPOSE AND SCOPE
The primary uses of dash cams are to assist in the Protection and Safety of Persons and Property, Prevention or Detection of Criminal Offenses, Defense of Legal Claims, and Monitoring Passengers.
The following principles apply:
4. DASH CAM RECORDINGS
Access is approved on an incident by incident basis. Once access is approved by the Designated Responsible Person, recorded footage can be reviewed (not deleted or amended) by:
2. Statutory bodies such as police
Any other person with interest must obtain authority from the Designated Responsible Person to view recorded footage, providing reasons and justification. Any persons whose images are recorded have a right to view those images, and to be provided with a copy of those images, within one month of making a written Subject Access Request. Availability of images will be subject to the retention period. Clients making such a request should do so in writing, providing the relevant time and date of the image, so that they may be easily identifiable. The request should be made to [Maxwell Mandell / Maxwellmhm@gmail.com] .
As stated, the primary uses of Dash Cams are to assist in the Protection and Safety of Persons and Property, Prevention or Detection of Criminal Offenses, Defense of Legal Claims and Driver Training. However, dash cams are likely to capture pictures of passengers.
Under appropriate circumstances the footage may be provided to Police (or other Competent Authority) with the intention to prosecute for criminal offenses. In defense of legal claims, or in pursuance of civil recovery, footage may also be provided to my legal representatives with the intention of providing evidence before the courts.
Where an incident involves a third party, the relevant insurers will be informed of the details. Although the third party may be made aware that there is recorded evidence in the form of Dash Cam footage, a copy of the recorded material can only be obtained if requested by the subject themselves. Third Parties should also be aware that under appropriate circumstances the footage may be provided to Police (or other Competent Authority) with the intention to prosecute for criminal offenses. In defense of legal claims, or in pursuance of civil recovery, footage may also be provided to my legal representatives with the intention of providing evidence before the courts.
7. MONITORING AND REVIEW
This policy will be regularly reviewed, or sooner if there is a policy need or legislative change.
By selecting “I agree” and by signing your name, you assume full responsibility for the completion and accuracy of this form. You further understand that any section not completed will affect the quality of Maxwell Mandell’s work. By this action, you indicate that you understand and agree to the terms and conditions and understand that they are legally binding.
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