Register for our Temp Service

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Directions: To register for our Temporary Nanny Service please complete the following information. Upon receipt we will call you to confirm your information and secure your credit card number for the annual registration fee.
- Required

Register for our Temp Service

Your Name:*
Email Address:*
Home Phone:*
Cell Phone:
Work Phone:
Spouse/Partner Name:
Work Phone:
Cell Phone:

How did you hear about us?:*

Additional Contact Information:

Is there anything else you want our Agency to know?:

Child's Name: Gender: Date of Birth: Allergies, Medicines,
Special Needs:

Pets Indoors:


Care Givers Placement Agency (“Care Givers” or "Agency") is a referral service that maintains records of Providers (“nannies”) who are screened and available to be employed by the Client to perform in-home domestic functions. Based on the information provided by the Client, Care Givers will refer available nannies to the Client and Client will pay a per-day referral fee each time a placement order is filled. IF CLIENT CANCELS A PLACEMENT ORDER CLIENT WILL BE CHARGED A CANCELLATION FEE EQUAL TO A 1-DAY REFERRAL FEE.  In addition, the annual registration fee, paid upon initial registration, will be charged every 12 months unless registration is cancelled by Client. 

Unless the Agency has received a one-time permanent placement fee for the specific provider the Client agrees to continue to pay the per-day referral fee whether arrangements are made by the Agency or directly with the nanny herself.

Care Givers is not the employer of any Provider retained by the Client, and is not responsible for the provider's direction, supervision, control or compensation. Client understands that they may be responsible for withholding and filing employment taxes for salaries paid to the nanny which exceeds the exemption limits set by the Internal Revenue Service. If Client instructs a Provider to transport their child(ren) in the Client’s or the Provider’s automobile, Client understands that Care Givers is not responsible for the safety of any child(ren) while being transported in any automobile. Client agrees to provide and install the appropriate safety seats in their family’s or the nanny’s automobile. Care Givers’ liability to Client is further limited in several ways. Because no screening process can provide complete accuracy, the Agency cannot guarantee the performance or qualifications of the Providers that are referred to Client. Client will release and hold harmless Care Givers Placement Agency, its agents, employees and officers for any and all claims of liability relating to or arising out of the referral and/or hiring of any Provider.  In the event that a court or arbitrator determines that Care Givers is responsible for damages, claims or injuries relating to this agreement or the performance of a Provider, Care Givers cannot be held liable for any amount over and beyond the fees paid by Client. Care Givers cannot be held liable for incidental or consequential damage. This limitation of liability exists regardless of whether a claim made against Care Givers arises in tort or in contract, including any claims based on negligence and cannot be modified or extended except by an explicit written agreement.

Client understands that the referral of a nanny to a third party, without arranging the referral through the Agency, is considered “theft of services” and will result in a charge of $500.00 in liquidated damages. An interest rate of 1.5% per month or the maximum permitted under law shall be charged on all fees past due. Client shall be responsible for payment of all costs and reasonable attorney fees incurred by Care Givers as a result of collection, including costs and attorney fees made in connection with court and/or arbitration proceedings. This agreement shall be construed and enforced in accordance with the laws of the State of Oregon. All actions to enforce or interpret this agreement, whether by court action or arbitration, shall be maintained in Multnomah County, Oregon.

I agree to pay according to my cardholder agreement with my Issuer.

* I have read the above terms and conditions, understand them and agree to accept them.

When we receive your registration we will call to get your credit card number.