Cardinal Nannies & Caregivers - Client Contact Form

If you are interested in our services please completely fill out the following form: If you have issues submitting the form, plase contact moyra@cardinalnannies.com

Name*
Address*
Address 2
City*
Province*
Postal Code*
Phone Number*	### - ### - ####
Work Phone*
Fax
Start Date*
Email
Children or elderly requiring care. Please indicate age and any special needs.*
Hours and days needed (3hr minimum).*
Pets*
Non-smoker preferred?*	yes   no
The caregiver would need a drivers license?*	yes   no
A car is required?*	yes   no
A car is Provided?*	yes   no
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*	Email   Telephone   Fax
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Cardinal Nannies and Companions Inc. will confirm the above information and set up a convenient time for a home visit from the owner.