Cardinal Nannies and Companions Inc. - Cardinal People Care... because you do

Client Form

If you are interested in our Services please fill out the following form

Name Home Telephone
Address Work Telephone
Address 2 FAX
City Start Date
Province Postal Code
E-Mail
Children or elderly requiring care.
Please indicate ages and any special needs.
Hours and Days Needed (3 hour minimum).
Pets
Yes No Non-smoker preferred?
Yes No The caregiver would need a drivers license?
Yes No A car is required?
Yes No A car is provided?
We require a caregiver: Live-in Live-out
Part-time Full-time
Long-term Short-term
Type of Placement Contract System Preferred Placement System Preferred
Contact me by E-Mail Telephone FAX

Cardinal Nannies and Companions Inc. will confirm the above infromation and set up a convenient time for a Home Visit from the owner.

	Cardinal People Care
	Cardinal Nannies & Companions Inc. 519 Dundas Street East Suite 3 Whitby, Ontario, Canada L1N 2J5 www.cardinalnannies.com	Phone: (905) 666-2228 Toll Free 1-800-219-8059 Fax: (905) 666-9689 E-mail: moyra@cardinalnannies.com

Name		Home Telephone
Address		Work Telephone
Address 2		FAX
City		Start Date
Province		Postal Code
E-Mail
Children or elderly requiring care.
Please indicate ages and any special needs.
Hours and Days Needed (3 hour minimum).
Pets
Yes No	Non-smoker preferred?
Yes No	The caregiver would need a drivers license?
Yes No	A car is required?
Yes No	A car is provided?
We require a caregiver:	Live-in Live-out
	Part-time Full-time
	Long-term Short-term
Type of Placement	Contract System Preferred Placement System Preferred
Contact me by	E-Mail Telephone FAX