Client's First Name:

Mobile Phone:

Email address:

Name of hotel or Residence:

Hotel or Residence Location:

Hotel or residence Phone:

Room reserved under the name:

Hotel room number:
(if available)

Service dates/times:

Dependent Information:  

Additional Information:

Type:

Name on Card:

Credit Card #(no spaces)

Expiration Date:

TLC For Kids Inc. Short-Term Care
Agreeement and Release:

Understanding between parties:

1.TLC agrees to make its best effort to locate temporary caregivers for client's child or companion care needs on a requested basis.

2. Client agrees to pay caregiver directly for services rendered at least $15.00 per hour for 1-3 children and $1.00 per hour per each additional child with a minimum of 4 hours of care plus any parking charge.   

Holiday rates: caregivers are paid time and a half ($22.50 per hour) on Thanksgiving, Christmas Eve (after 5p.m.), Christmas Day, New Year's Eve, New Year's Day, Easter, Labor Day, Memorial Day, and 4th of July.

3. Client understands that a $40.00 per visit, non-refundable agency reservation fee will be charged to client's credit card upon TLC's confirming client's reservation (via telephone, email, or text message) for each caregiver reservation .

If client cancels the reservation with less than 24 hours notice an additional $60.00 will be charged to the credit card in order to compensate the nanny for loss of income.

Holiday rates: Agency fee is $50.00 per visit on Thanksgiving, Christmas Eve (after 5p.m.), Christmas Day, New Year's Eve, New Year's Day, Easter, Labor Day, Memorial Day, and 4th of July.

4. Client understands that the services provided by all caregivers associated with TLC must be contracted through the TLC office. Client agrees that he/she will not hire or refer a TLC caregiver to a third party without the consent of the TLC office. Client further understands that use of TLC caregiver without arranging the visit through the agency will result in a charge of $1800.00 for liquidated damages for theft of services.  In the event that client wishes to hire caregiver on a permanent basis, TLC agrees to negotiate with client in arriving at an acceptable placement fee. TLC's standard placement fee for a caregiver is 10% of the caregiver’s projected gross annual compensation, with a minimum of $1,500 for part-time (under 40 hours per week) and a minimum of $2,500 for full-time (40 or more hours per week).

5. Client understands that TLC caregivers are not employees of TLC. Client understands that client may be responsible for withholding and filing employment taxes for each calendar year in which the caregiver's payments exceed the limits set forth in the Internal Revenue Code. Social Security numbers of caregivers must be obtained directly from caregivers.

6. Client agrees to forever indemnify, release and hold harmless TLC, its agents, employees and officers for any and all claims relating to services provided by caregivers.

7.Client understands that the hotel swimming pool is completely off limits with a TLC caregiver. Caregiver may not take client's children swimming in the hotel pool.  (A separate written waiver can be executed with the office for swimming, please contact TLC for more information).

8. Client understands that a caregiver may not take children off of the hotel premises without written permission from the parents.

I agree

I disagree

Medication Release: (optional)

I hereby give consent for a TLC caregiver whom I have hired for care at a hotel, to administer medication. I understand that TLC caregivers are not medically trained. I hereby release, discharge and hold harmless TLC, its employees, agents, and officers from any and all claims relating to the dispensing and administering of medication.

I consent to administer medication

I disagree