Parents in a Pinch Application Registration for Childcare Services Please complete this form and e-mail it back to us. We will call you upon receipt of this application for your credit card information. I understand that the childcare workers referred by the Agency on temporary assignments are my employees and that the Agency is not their employer. If I employ a worker on a referral from the Agency, in consideration of the referral, screening and support services provided by the Agency, I authorize the Agency to charge my credit card for the Registration and Agency Fees as described in the fee schedule enclosed.
Fees are subject to change.
I will use the services of the childcare workers referred by the Agency only when contracting through the Agency. I hereby agree to hold the Agency harmless of any and all loss, damage, destruction or accident claims which may arise out of or in connection with the rendering of any services by any worker referred by the Agency. Provider must have a car Provider may use family car for transporting children, shopping, etc. Provider must have a driver's license.