Crunch Care-Servicing San Diego-Babysitters, Nannies, Caregivers, Baby Registry, Corporate Benefits

Client Application

Crunch Care, A Nanny and Caregiver Referral Agency

Taking the time to fully understand our client's needs is what makes our placement process so successful. Before you begin working with us we ask that you fill out the application below. It details all of the specific requests you may have for your family's specific situation and will help us make a placement or help us help you make a decision that is an appropriate choice. We are dedicated to making sure that you are completely happy with the process and the end result.

The form below is not only a needs assessment, it specifies what you can expect from us as a client and is a contract defining our terms of service. We look forward to being an extension of your family and helping to make your life easier. Please call our office any time if you need additional assistance or simply would rather discuss by telephone at 877-553-4231.

If you would rather print out and manually fill our our Client Application and Agreement click here. It can be faxed once completed to 480-287-9138.

If you would like to print out a copy of our sample Emergency Contact Sheet please click here.

We look forward to working with you.

Client Application
ALL SERVICES

Type of Care:
Full-Time or Part-Time:
Check here if you are a Candidate Crunch Client
Client Name:
Email:
Mobile:
Home Number:
Office Number:
Best Number to Contact:
Current Street Address:
City:
State:
Zip
How Did You Hear About Us:
Referred By (if applicable):
Location of Service if other than the address listed above: Please include street address, city, state, and zip.
Client Name 2:
Email:
Street Address:
Home:
Office:
Best Number to Contact:
I will need care for:



Schedule and Assessment Please be as descriptive as possible when filling out the hours of care you will need. Specify if you will need a.m., p.m., or 24 hour shifts.
Date of service (if not sure please indicate):
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Please use this area to describe any special requests regarding your schedule needs:
The section below applies to all types of care. Please check the boxes that apply to your needs.
Live-In
Live-Out
Driving
Driving children to activities
Misc. errands
Reading aloud
Meal planning and preparation
Grocery shopping
Changing bed linens
Sweeping
Making beds
Vacuuming
Dusting
Laundry
Household organization
Dog walking
Pet feeding
Plant maintenance
Mail pickup
Walks or outdoor activity
Please fill out the following checklist for Newborn/Post-Delivery Care only:
Sleeping in newborns room
Night feedings or participation in night feedings
Care of umbilical cord
Newborn Bathing
Birth of multiples
If applicable list how many:
C-Section delivery
Please fill out the following checklist for Elderly Care only:
ADLS (Activities of Daily Living)
Assistance dressing
Dementia
Alzheimer's
Smoking
Incontinence
Emptying Colostomy or Catheter Bag
Bathing Assistance
Recording (not administering) medication dosing
Lifting to stand
Oxygen or Nebulizer use
Terminally ill
Transport in or out of bed or wheelchair
Range of motion activities
Undergoing Dialysis
Undergoing Chemo or Radiation treatment
Feeding tubes
Click here to fully review the Crunch Care, Inc. Family/Client Agreement (Print full document for your records).
By entering my initials in the box to the right, I hereby agree to the terms and conditions stated above in this Client Application and to all the terms and conditions in the Crunch Care, Inc. Family/Client Agreement.
I am entering my initials to confirm that I have been given the following information: I have been told that TrustLine is California's registry of in-home child care providers, tutors and in-home counselors who have passed a background screening. It was created by the California Legislature in 1987 and is a powerful resource for parents hiring a nanny or baby-sitter. All caregivers listed with TrustLine have been cleared through a fingerprint check of records at the California Department of Justice. This means they have no disqualifying criminal convictions or substantiated child abuse reports in California. TrustLine is administered by the California Department of Social Services and the non-profit Child Care Resource and Referral Network. It is endorsed by the California Academy of Pediatrics. For more information visit www.trustline.org. An employment agency is prohibited by law from placing a child care provider unless the provider is a Trustline applicant or a registered child care provider. Parents can check if a provider is registered on TrustLine by calling 1-800-822-8490. You'll need to provide (1) the person's full name and (2) driver's license number.
Additionally, by entering my initials in the box to the right, I: (1) agree to provide all of my necessary billing information to Crunch Care; (2) agree to provide Crunch Care with a valid credit card for my billing; (3) understand and agree that Crunch Care shall charge my credit card for all fees, charges and costs pursuant to the Crunch Care, Inc. Family/Client Agreement; and (4) agree to pay all such fees, charges and costs on my credit card to Crunch Care.
By entering my initials to the right I understand on all temporary bookings there is a 72 hour cancellation policy. I accept that a charge to my credit card of 4 hours of time will be processed:
Upon submittal of this form you will be taken to the site home page. We will contact you shortly regarding your request. FOR URGENT STAFFING NEEDS in addition to filling out this form please contact us by phone at 877-553-4231, ext. 1. We will handle your request with a strong sense of urgency. Please print and retain a copy of your completed Client Application for your records.