Choice Care Agency Inc. Tucson Nanny Service

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Contact Us
Ph.(520) 322-6966
Fax.(520) 320-7711
2504 E. River Rd.
Suite 100
Tucson, AZ 85718

RegistrationForm

Parent/Guardian:

Street address:

(No P.O. Box)

City:

State:

Zip:

Phone:

- -

Fax:

- -

Email address:

Directions: Please provide us with EXACT directions to your home
(we will provide to your caregiver)
Largest (major) intersection closest to your home:

From this intersection we proceed on what street:

Please provide the remainder of your directions using LEFT & RIGHT turns:

How did you hear about us?

If 'other' or 'referral', please tell us who to thank:

personalinformation

Parent/Guardian's employer:
Work phone:	- -
Cell phone:	- -
Parent/Guardian's employer:
Work phone:	- -
Cell phone:	- -
Emergency contact:
Relationship:
Phone:	- -

requestservices

I/we shall not refer a Choice Temporary to any other family seeking services at any time. If a Choice Temporary is referred to any family for any type of work, without notifying Choice Care, I/we shall pay Choice Care an amount equal to twice the fee for a permanent placement, plus costs and attorney's fees, if any.

I/we understand that all Choice Temporary's wages are the responsibility of the below signed party. All Choice Temporaries are independent contractors and are to be paid directly. I/we understand all placements are contingent upon availability and there is no guarantee that every position can be filled. Services are to be requested through agency ONLY. Please do not contact any Choice Temporary directly.

I have read and accept all charges.

Please register my family with Choice Care (no charge) - form must be completed to utilize service.

I/we wish to be registered as a Preferred Status client ($150 fee).

PREFERRED STATUS CLIENTS:
Preferred Status client request will receive priority over clients who are NOT preferred. Without preferred status, all jobs will be filled on a first come first serve basis.