Perfect Harmonies Childcare and Development

1
Name* This field is required.
First Name
Last Name
2
Address
Street Address
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City
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Afghanistan
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New Caledonia
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Niger
Nigeria
Niue
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Country
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Area Code
Phone Number
5
Type of Service
Professional Babysitting
Group Babysitting
6
Date Reservation* This field is required.
7
Times* This field is required.
1
2
3
4
5
6
7
8
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10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
Until
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
8
number of children
9
Any special requests or instructions?
10
Service Agreement* This field is required.Waiver of Liability, Release, Assumption of Risk & Indemnity Agreement Notice: This is a legally binding agreement. I understand that by signing this Service Waiver of Liability, I release and hold harmless Perfect Harmonies Childcare and Development LLC., and its owners, directors, officers, advisors, employees, agents, instructors, volunteers, childcare workers, Family Assistants and Babysitters and all other persons or entities acting for them from any and all claims, demands, suits, costs, attorney fees and charges, in connection with or arising out of Perfect Harmonies Childcare and Development LLC., Babysitting and Family Assistants service, including but not limited to, personal injury, bodily harm/injury, death, losses, damages or property damage occurring while my child/children is/are in the care of Perfect Harmonies Childcare and Development LLC. I understand I must pay the set Booking and hourly fees. I understand that if my child(ren) should become inconsolable during any services provided by Perfect Harmonies Childcare and Development/Family Services hours, I am responsible for his or her or (their) actions and behavior and will not hold Perfect Harmonies Childcare and Development and it's staff responsible. By submitting this form I agree to provide a safe and habitable and animal free place and/or space for all services to be provided in. By submitting this booking form I understand and agree with all terms stated in this agreement.
YESNO
11
Booking Fee* This field is required.
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ORDER SUMMARY
Total costUSD
Booking FeeBooking Fee for Babysitting Services
$10.00Edit
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Total cost $0.00
12
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