Family Registration Fill out the fields below to register your new account. Fields marked with a red asterisk are required. Name Username* Password* Repeat Password* E-mail* Street Address* City* State* AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code* Guardian 1 Guardian 1 First Name* Guardian 1 Last Name* Guardian 1 Phone* Guardian 1 Email Guardian 1 Occupation* Relation to Child (1)* Guardian 2 Guardian 2 First Name Guardian 2 Last Name Guardian 2 Phone Guardian 2 Email Guardian 2 Occupation Relation to Child (2) Child 1 Child 1 - Name* Child 1 - Date of birth or estimated due date: * Child 1 - Gender MaleFemale Child 1 - Any special requirements, circumstances, allergies, needs, etc.? Child 2 Child 2 - Name Child 2 - Date of birth or estimated due date: Child 2 - Gender MaleFemale Child 2 - Any special requirements, circumstances, allergies, needs, etc.? Child 3 Child 3 - Name Child 3 - Date of birth or estimated due date: Child 3 - Gender MaleFemale Child 3 - Any special requirements, circumstances, allergies, needs, etc.? For additional children, please list the in the comments section below. Hourly rate: $17-$20 per hour$20-$25 per hour$25-$30 per hour Please contact Kiddie Up to discuss typical hourly rates. Commitment term: Permanent >6+ monthsTemporary <6 monthsUnsure Tell us more about the schedule. Please be as detailed as possible and list the days of the week, start and end times, and number of hours per week you anticipate needing. Any pets in the home? * YesNo If you indicated "yes" for pets in the home, please list: If you are pursuing a nanny share, please note the other family’s name: How did you hear about us?* Attended class or workshopInternet searchReferral If you heard about us another way, please let us know: Additional Comments Prove you are a human*Send these credentials via email.