Registration for parents

If you have problems with the form, please contact us by phone at 076 370 06 62 or E-Mail. We are glad to help you.

Personal Data:

First Name:*

Missing or incorrect input

Surname:*

Missing or incorrect input

Adress:

Missing or incorrect input

Zip Code/Town:

Missing or incorrect input

Telephone:

Missing or incorrect input

Mobile:

Missing or incorrect input

E-Mail:*

Missing or incorrect input

Date of Birth:

Mother:

Ungültige Eingabe

Father:

Invalid Input

Marital Status:

Invalid Input

Profession:

Mother:

Invalid Input

Father:

Invalid Input

Nationality(ies):

Missing or incorrect input

Confession(s):

Invalid Input

Children:

How many?

Invalid Input

Surname/Name:

Invalid Input

Date of Birth:

Invalid Input

Surname/Name:

Invalid Input

Date of Birth:

Invalid Input

Surname/Name:

Invalid Input

Date of Birth:

Invalid Input

Surname/Name:

Invalid Input

Date of Birth:

Invalid Input

Business adress Mother:

Invalid Input

Tel.:

Invalid Input

Business adress Father:

Invalid Input

Tel.:

Invalid Input

Additional Emergency address:

Invalid Input

Tel.:

Invalid Input

G.P./Pediatrician:

Missing or incorrect input

Tel.:

Fehlende oder falsche Eingabe

Dentist:

Fehlende oder falsche Eingabe

Tel.:

Fehlende oder falsche Eingabe

Health Insurance Co.:

Missing or incorrect input

Tel.:

Fehlende oder falsche Eingabe

Kindergarten/School:

Invalid Input

Tel.:

Invalid Input

Name of teacher:

Invalid Input

Tel.:

Invalid Input

(Please inform the teaching staff about the HappyNanny- care-giving situation!)

Family Situation:

Housing: (Size of the flat/house, environment, kindergarten, school, etc.)

Invalid Input

Free time activities:

Invalid Input

Do you have pets?

YesNo Fehlende oder falsche Eingabe

What pets do you have?

Invalid Input

Do you smoke?

YesNo Fehlende oder falsche Eingabe

Wishes for Day-care:

How many children would you like care for?

Fehlende oder falsche Eingabe

How many days would you like care for your children?

Invalid Input

In which intervals would you like to have your child cared for? (which days/hours)

Monday (from/to)

Invalid Input

Tuesday (from/to)

Invalid Input

Wednesday (from/to)

Invalid Input

Thursday (from/to)

Invalid Input

Friday (from/to)

Invalid Input

Saturday (from/to)

Invalid Input

Sunday (from/to)

Invalid Input

Which pick-up and drop-off times would you like?

Invalid Input

Where should your child be cared for?

at the HappyNanny’s home

at the family home

it doesn’t matter

Fehlende Eingabe

About when should the care begin?

Ungültige Eingabe

Characteristics of the HappyNanny:

Are pets welcome?

YesNo Invalid Input

Which pets are welcome?

Invalid Input

Are smokers welcome?

YesNo Fehlende Eingabe

Characteristics of the HappyNanny:

What else is important for you regarding the HappyNanny?

Invalid Input

Characteristics of the children to be cared for:

Eating habits:

Breakfast:

Invalid Input

Lunch:

Invalid Input

Dinner:

Invalid Input

Sleeping habits:

Invalid Input

Illnesses:

Invalid Input

Specific things about your child/children: (Allergies, Therapies, etc.)

Invalid Input

Special wishes/expectations/limitations/comments:

Invalid Input

Miscellaneous:

Is the HappyNanny allowed to take field trips with your child/children? (for assumtion of costs!)

YesNo Invalid Input

Emergency medical call:	Tel. 144
Kantonsspital Luzern:	Tel. 041/205 31 66
Toxikologisches Institut Zürich:	Tel. 044/251 51 51

*

I hereby confirm that I have truthfully completed this questionnaire

Missing information

Lüscher's HappyNannies

Yes, we are family!

Looking for a nanny?

Registration Form for Parents

Please fill in all mandatory fields!

If you have problems with the form, please contact us by phone at 076 370 06 62 or E-Mail. We are glad to help you.

Personal Data:

Family Situation:

Wishes for Day-care:

Characteristics of the children to be cared for:

Miscellaneous:

If you have problems with the form, please contact us by phone at 076 370 06 62 or E-Mail. We are glad to help you.