Gentle Hands Newborn and Postpartum Care
Applicant's Form
This form is for service inquiries only.

Gentle Hands is a referral and employment agency that agrees to provide services for clients seeking Baby Nursing, Postpartum Care and Labor Support Doulas and Nannies.

All of our staff are certified in CPR and First Aid with certifications in their respective fields of employment.

Use this form to send your application to us via e-mail.
Client's Full Name:
Spouse's Full Name:
Address:
Cross Street:
Apartment Number:
City:
State:
Zip Code:
Home Phone:
Fax Number:
E-mail:
Client Occupation:
Work Phone:
Work Fax:
Cell Phone Number:
Spouse Occupation:
Work Phone:
Cell Phone:
Client Due Date:
Age of New Born:
Please check type of care needed:
24 hour care live-in
8-10 hour night-time
12 hour care night-time
8-10 hour care day-time
12 hour care day-time
We are seeking care for:
Single Baby
Twins
Triplets
Boy
Girl
Sex of baby unknown
*Length of Time requested:
*Required Minimum of 10 days
Nanny's Work Schedule
Mo. - Fr.
Start:
Finish:
Tu. - Sa.
Start:
Finish:
Weekends
Start:
Finish:
Desired Starting Date: Immediately or on
Is your home accessible by bus or train?     Bus     Train
Is this your first baby? If you have other children, please list.
Please describe your ideal Baby Nurse:
Have you had a Baby Nurse before?     Yes      No  
Are there any pets in the home? If yes, please explain.
If you request a 24 hour-care Nurse please tell us about her accommodations.
Private Bedroom
Shared Baby's Nursery
Private Bathroom
Shared Bathroom
TV
Other
Please describe
Additional Information:
How did you hear of us?
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Gentle Hands
Phone: 212-767-9173
www.GentleHandsChildcare.Com
E-mail: gentlehands@GentleHandsChildcare.com