PARENT INFO FORM

Select those which apply: Y=Yes, N=No, D=Depends, S=Some

PERSONAL INFORMATION OF EACH CHILD 

(Please provide the following information about your children.)

Name | Sex | DOB | School Schedule

PARENTS MUST TAKE PRECAUTIONS TO MAKE FIREARMS INACCESSIBLE.

FAMILY LIFESTYLE 

Nanny Qualifications/Job Duties:

Please describe each child’s personality, development stage, special needs, health concerns, allergies, and medications.

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ONCE THE ABOVE PARENT INFO FORM HAS BEEN COMPLETED AND SUBMITTED, WE WILL EMAIL YOU THE PROPRIETARY INFORMATION AGREEMENT, PAYMENT AGREEMENT, CLIENT ACKNOWLEDGMENT AND RELEASE, AND THE HOUSEHOLD DISCLOSURE AGREEMENT FORMS TO GET THE PROCESS STARTED. 

Everything below this point is simply for your review before we send it via email to collect your signature and other pertinent information.

Please scroll down to the bottom of the page to hit the submit button.

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PROPRIETARY INFORMATION AGREEMENT

Each of the undersigned further acknowledge that any and all information, including, but not limited to, the candidate's file, is confidential and the property of A CHOICE NANNY. Because I/we acknowledge that such proprietary information is confidential, I/we agree not to disclose to any person or entity the name and address or any other information relating to any candidate. I/ We further agree that if such disclosure is made by me/us and as a result a Candidate is hired without the use of A CHOICE NANNY'S service, I/we will be responsible for the Fee that would have been due to A CHOICE NANNY at the time the Candidate was hired, along with any other damages and/or ACN as a result of such disclosure. 

THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT IN WITNESS WHEREOF; WE HAVE HEREUNTO SET OUR HANDS AND SEAL

CLIENT ACKNOWLEDGMENT AND RELEASE

I/We, the undersigned, hereby acknowledge that I/we have engaged the services of CSF, Inc. (the "Center"). I/We further understand that the Center specializes in the referral of dependent care provider candidates (the "Candidate(s)") for occasional, temporary, and ongoing dependent care.

I/We understand that upon hiring a Candidate for ongoing dependent care or for occasional or temporary care, I/we shall be required to pay the applicable Center referral fee (the "Fee"). If, however, I/we subsequently hire a Candidate for ongoing care, whom I/we have previously used for occasional or temporary care, the Fee assessed for the referral of an ongoing dependent care Candidate will then be payable.

I/We further acknowledge that the Center does not maintain an employer/employee relationship with any of the Candidates. Accordingly, I/we accept that it is my/our responsibility to interview any Candidates selected for referral by the Center and to perform an independent inquiry, in addition to any inquiry performed by the Center into each Candidate's references and background, prior to a final selection of any Candidate hired by me/us. I/We understand it is my/our responsibility to obtain from the Center all back-up paperwork on the Candidate I/we have hired.

Each of the undersigned further acknowledges that any and all information, including, but not limited to, the Candidate's file, is confidential and the property of the Center. Because I/we acknowledge that such proprietary information is confidential, I/we agree not to disclose to any person or entity the name and address or any other information relating to any Candidate.

In consideration of the services of the Center and of the personal benefits and advantages received by me/us as a result of these services and being fully aware of the potential risks and hazards inherent in hiring a person to provide care for a dependent, I/we unconditionally accept and assume any and all risks involved in hiring a Candidate referred to me/us by the Center.

Each of the undersigned exempts and releases ACN Holding, Inc., the Center, its directors, officers, shareholders, agents, and employees from all actions, causes of action, claims and demands for injuries, accidents, sickness and damages of whatsoever nature, which may be sustained by me/us or our dependent in consequence of using the services of the Center. 

Each of the undersigned, individually and as parent(s) and natural guardian(s), hereby agrees to indemnify and save harmless the Center from all injuries, losses, damages, and expenses, should any claim, demand or suit be made by or on behalf of my/our minor child(ren) in consequence of using the services of the Center.

This release extends and applies to all unknown, unforeseen, unanticipated and unsuspected injuries, damages, losses and liabilities, and the consequences of them, as well as those, which may have been disclosed and presently known to exist. The provisions of any state, federal, local or territorial law or statute providing, in substance, that releases shall not extend to claims, demands, injuries or damages which are unknown or unsuspected to exist, at the time to the person executing such release, are expressly waived.

Any controversy or claim arising out of or relating to this Acknowledgment and Release shall be settled first by mediation and, if unsuccessful, then by arbitration. Such arbitration shall be conducted in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrator(s) may be entered in any court of competent jurisdiction.

I(WE) HAVE READ THE ABOVE ACKNOWLEDGMENT AND RELEASE AND FULLY UNDERSTAND IT. 

PAYMENT AGREEMENT

Agreement (hereinafter called "Agreement") made this between CSF CORPORATION a Maryland corporation doing business as A CHOICE NANNY, (hereafter called the ("SERVICE"), in HOWARD COUNTY, State of Maryland, and (hereafter called the "Client").

This agreement is in effect for one year from the signing date.

In exchange for the services rendered and to be rendered, Client agrees to make the payments as promised in this Agreement.

1. Client has paid a one-time non-refundable Membership/Application Fee of $300.00 and has become a member of Service for the purpose of obtaining the assistance of Service in locating a person (hereinafter called "NANNY”), to assist in caring for child or dependent on a full time, part-time, on-going, or temporary basis.

2. Client agrees that if he/she/they use(s) the services of a Nanny referred by Service, Client shall be liable to Service for any and all fees specified in this Agreement. Client further agrees that if the Nanny is hired on a Temporary, Occasional, Part-time, or Summer basis for any type of work, including non-dependent care services, and is later used for more than Temporary, Occasional, Part-time or Summer basis, Client shall pay the balance of any additional fees for such services.

3. Nannies referred to by the service are defined as:

Caregivers 18 years of age and older who come into the Client's home or other place as designated by Client and care for children or other dependents. A nanny shall in no event be an employee of service, but rather, shall be an employee of Client.

4. Referral for on-going services of Nannies shall be classified as follows:

(a) FULL-TIME: Care by which an ongoing and regular arrangement is made between Client and Nanny where the Nanny works 30 hours per week or more.

(b) PART-TIME: Care by which an ongoing and regular arrangement is made between Client and Nanny where the Nanny works fewer than 30 hours per week or more.

(C) TEMPORARY: Care, which is not pursuant to an ongoing and regular arrangement.

5. Client agrees to pay directly to Service a fee for the assistance provided in accordance with the schedule set forth below. It is the responsibility of the Parent to notify A CHOICE NANNY once a nanny accepts their job offer. The BACKGROUND CHECK will not be done until we know whom you have hired.

ALL FEES ARE DUE AND PAYABLE TO SERVICE WHEN CARE BEGINS.

* ALL FEES ARE SUBJECT TO CHANGE.*

a) Upon acceptance of a Nanny providing care, a Referral Fee will be charged as follows:

REFERRAL FEE SCHEDULE

PART-TIME NANNY - 4 x full week's gross pay 

& TUTORCARE NANNY - (Minimum of $1200.00: 1-18 hours per week.)

(Live-Out) - (Minimum of $1800.00: 19-29 hours per week.)

* An additional fee will be charged for a Nanny who has additional hours or days added to her job. 

FULL-TIME NANNY: $2500.00

(Live-Out)

LIVE-IN NANNY: $3000.00

(Full-time or Part-time)

SUMMER NANNY: $500.00 (For Mid-June to End of August Only)

*An additional fee will be charged for a Nanny who continues beyond the summer, and the summer fee will be applied to the additional fee.

NANNY WHO BRINGS HER OWN CHILD:   20% discount on any of the above applicable fees. (Applies to Full Time & Part Time Referral fees.) 

OCCASIONAL EVENING:   No fee (After 6:00pm Monday through Sunday) 

TEMPORARY, OVERNIGHT & WEEKEND CARE: $20.00/day of care (1-24 hours per calendar day.)

$15.00/day of care (5" consecutive calendar days.)

*Temp fees are automatically charged to client's credit card.

(b) $100.00   annual update fee will be charged if a new search is needed

(C)Checks may be written and sent to:

A CHOICE NANNY

3545 Ellicott Mills Dr. 

SUITE 205 

Ellicott City, MD 21043

(d) Payment of the fee must be guaranteed by a major credit card or paid in advance by check for the estimated fee. A 1 1/2% finance fee will be charged per month to any unpaid balance. Credit card payments are charged to Client's credit card and the Client hereby authorizes such charges according to the fee schedule.

(e) Fees for Temporary care must be paid monthly and will automatically be charged to Client's credit card unless another form of payment is received by Service one week in advance.

(f) Credits against fees may be extended by the Service in accordance with the Guaranty Policy in effect at the signing of this agreement.

6. This Agreement cannot and should not be construed or interpreted as a partnership or joint venture between the Client and Service. Client(s) acknowledges that he/she/they have signed the Client Acknowledgment Release on back of the Parent lnfo form (copy attached) and have received a copy of Service's Guaranty Policy (copy attached).

7. Any controversy or claim above Small Claims Court limit arising out of or relating to this Agreement shall be settled by arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The parties hereto agree that the arbitration shall be held in Howard County Maryland.

8. The parties acknowledge that they have read and understand all the terms and conditions set forth in this Agreement. This instrument constitutes the entire Agreement and all prior negotiations and understandings have been merged herein. No modifications of this Agreement shall be valid unless in writing and executed by the parties.

GUARANTEE OF PAYMENT

A CREDIT CARD NUMBER IS NECESSARY BEFORE A SEARCH BEGINS. WE WILL CONTACT YOU SHORTLY FOR PAYMENT UPON PROCESSING OR YOU CAN CALL US AFTER SUBMITTING THE FORM.

Payment may be made by cash, check, money order, or a major credit card. Payments not received in Service's office when due will automatically be charged to Client's credit card and Client hereby authorizes such charges.

GUARANTEE POLICY

If, for any reason, the Nanny leaves or care is terminated within 16 weeks of hire (eight weeks for a summer nanny), there will be a new referral fee for a new nanny. However, client will receive a prorated credit towards a new nanny, based on the number of weeks the Nanny was employed. Client's final fee will be divided by 16 weeks (eight weeks for a summer Nanny) and a credit will be given for the weeks the Nanny was NOT employed. This credit is good for one year.

EXAMPLE:

If the final fee was $2500.00 and the Nanny leaves after four weeks, the credit will be:

The final fee was $2500/16 (Guaranteed weeks) = $156.25 per week. $156.25 per week x four weeks = $625.00 (Guarantee used)

$2500.00 (Final fee) - $625 (Guarantee used) = $1875.00 (Guarantee credit)

Client hereby recognizes that a written Nanny and Parent Agreement is instrumental in the nanny staying on the job. Parent hereby acknowledges that this credit policy will be null and void without such an agreement, and that a copy of the agreement must be received in this ACN office within TWO WEEKS of hire.

RECEIVED AND ACKNOWLEDGED

HOUSEHOLD EMPLOYER'S DISCLOSURE

Household Employee versus Independent Contractor: You have a household employee if you hired someone to do childcare/household work. The worker is your employee if you can control not only what work is done, but how it is done.

According to the IRS, if only the worker can control how the work is done, the worker may not be your employee but as self-employed (independent contractor). A self-employed worker (independent contractor) usually provides his or her own tools and offers services to the general public as an independent business.

Household Employer Responsibility Information: As a Household employer you are to act in accordance with the Fair Labor Standards Act and IRS Publication 926, Household Employers Tax Guide.

The Fair Labor Standards Act: The Fair Labor Standards Act of 1938 (referred to as "the Act" or "FLSA") establishes minimum standards for both wages and overtime entitlement. The Act spells out administrative procedures and provisions related to child labor standards and equal pay.

(a.) Effective JAN.2021 please be advised that the minimum wage rate for Maryland will increase to $12.20/hr. and the minimum wage for Montgomery County will increase to $14.00/hr for employers with 10 or fewer employees. In Howard County the minimum wage is $13.25/hr and will gradually rise to $16 hr by July 1, 2026.

(b.) Employees who do not live with their employers are eligible for overtime pay at a rate of not less than 1.5 times their regular rate of pay.  The laws vary from state to state and the employer needs to refer to state law.

Workers Compensation- Most states require a household employer to carry a worker's compensation and/or disability policy if the employer employs someone on a full time or part time basis.

(a.) Employers in the State of Maryland are required to obtain workers' compensation insurance.

(b.) Employers having questions should contact the State of Maryland Workers' Compensation Commission at http://www.wcc.state.md.us/

Household Employers Tax Guide, (Publication 926)- This publication will help you decide whether you have a household employee and, if you do, whether you need to pay state and federal employment taxes (social security tax, Medicare tax, state and federal unemployment tax, and state and federal income tax withholding). It explains how to figure, pay, and report these taxes for your household employee. It also explains what records you need to keep.

(a.) If you pay your nanny cash wages of $2,600 or more in 2023, all cash wages you pay to that employee in 2023 (regardless of when the wages were earned) you are required to pay social security and Medicare wages.

(b.) You are not required to withhold state and federal income tax from wages you pay a household employee. You should withhold state and federal income tax only if your household employee asks you to withhold it and you agree. Most nannies prefer the employer to withhold state and federal income tax from wages.

(C.) This publication also tells you where to find out whether you need to pay state unemployment tax for your household employee.

GTM Household Employer Experts- GTM is a household tax, payroll, and human resource management service.

(a.) They offer complete tax and payroll services for households who employ a nanny including paycheck calculation and distribution, direct deposit, tax savings, and electronic tax filing.

(b.) They make sure their clients comply with state and federal regulations.

(c.) Employers having questions should contact GTM at 888-432-7972 (M-F 8:30 a.m. - 6 p.m. EST) or http://www.qtm.com/

Client hereby recognizes and acknowledges that they have been advised of the Household Employer's Disclosure and provided the name and telephone number of a payroll tax service from A Choice Nanny.