All information recorded is kept safe, secure and confidential. The form below is to be filled in if you require a babysitter or au pair. How many children do you require assistance for? ---123456789 Your children's names and their date of birth: A BabysitterAn Au Pair Which date or start date would you require them on: Any special requests: Your Name: Your Surname: Your Email Address: Your Contact Number: Alternative Contact Number: In Case of Emergency: Contact Name: Contact Number: Your Address: How did you hear about us: FacebookLinkedInGoogle searchFrom a friend If from a friend, who? Click here to read our Terms and Conditions of service for a private babysitter. I have read and fully understand the agreement between myself and Babysitters Club and therefore release Babysitters Club of liability, indemnity and agree to all such terms and conditions. I confirm that the above information to the best of my knowledge to be correct and true and understand all the information stated above. Please click here if you agree to these terms.