Family Registration Form

Please complete the following aplication in order to register with our agency. A representative will call you within 12 hours to speak with you in more detail about your familiy application.

Name:
Address:
City:
State:
Zip:
E-mail:
Phone:
Office Number :
Fax Number :
Type of Nanny Preferred :
 Live In Live Out
Nanny Start Date:
Additional Information :
Please provide a brief description of the nannies duties:

 

You may also mail/fax this infomation to:

Dakota Nanny Company
29 Valley Road
Montclair, NJ 07042
Phone: 1-800-994-8585
Fax: 973-509-5281
E-mail: info@dakotananny.com