Family Placement Agreement

Family Information

Please tell us about your family so we can prepare for your consultation and match you with the right caregiver.

Parent’s First Name

Parent’s Last Name

Email Address

Phone Number

Preferred Contact Method

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Child Information

Tell us about your child(ren) so we can match your family with the most suitable caregiver.

Child Information

Child’s First Name

Child’s Last Name

Child’s Gender

Child’s Age

Does your child have any allergies?

Medical Conditions

Dietary Restrictions

Current School / Daycare (if applicable)

Typical Nap Schedule

Favorite Activities & Interests

Care Requirements

Tell us about the type of care you’re looking for so we can recommend the best caregiver for your family.

What type of childcare are you looking for?

When would you like care to begin?

Describe the schedule you need.

What duties would you like your caregiver to assist with?

Do you have any preferences for your caregiver?

Household Information

Help us understand your household so we can recommend the best caregiver for your family.

Are there pets in the home?

Please describe your pet(s)

Does anyone smoke inside the home?

Will the caregiver be expected to drive?

Will a family vehicle be provided?

Is parking available?

Will anyone else regularly be in the home during care?

Emergency Contact Name

Emergency Contact Phone

Is there anything else we should know about your household?

Position Information

Tell us about the caregiver position so we can find the best match for your family.

Expected Start Date

Expected Length of Placement (if temporary)

Typical Start Time

Typical End Time

Schedule Notes

Preferred Compensation Range

Desired Qualities in a Caregiver

Additional Comments

Live-In & Transportation Requirements

Please answer the following questions so we can match you with a caregiver whose availability and transportation needs align with your family’s requirements.

If live-in, describe the caregiver’s private living accommodations

Will the caregiver drive the children?

Yes

No

Will the family provide a vehicle?

Yes

No

Will mileage/gas be reimbursed?

Yes

No

Not Applicable

Additional Transportation Details

Duties & Work Schedule

Please tell us about the responsibilities and daily routine you expect your caregiver to manage.

Please describe the typical workday and workweek

Is there any additional information you would like candidates to know about your family?

Have you employed a nanny before? If yes, briefly describe the experience.

Placement Fee Schedule

Please review the HavenNest Placement Fee Schedule before continuing.

Placement Fee	15% of the caregiver’s projected first-year gross compensation
Minimum Schedule	20 hours per week
Search Initiation Fee	$500, applied toward the total placement fee
Included Screening	One standard professional background screening for the selected candidate
Payment Due	Remaining placement fee due when the Client hires or engages a referred candidate

Placement Fee Calculation

1. Annual Hours	Hours per day × days per week × weeks per year
2. Annual Compensation	Annual hours × hourly wage
3. Placement Fee	Annual compensation × 15%
4. Amount Due at Placement	Placement fee minus the $500 search-initiation fee

The placement fee is a one-time referral fee. Unless otherwise stated in writing, the fee includes one standard background screening for the selected candidate. Additional screenings or third-party services requested by the Client may be billed separately.

Client Initials

Date

Please carefully review the following terms and conditions before proceeding. By continuing, you acknowledge that you have read and understood the HavenNest Family Placement Agreement.

1. Services and Candidate Referrals

HavenNest locates, recruits, interviews, screens, and checks references of potential caregivers for the purpose of providing qualified referrals to families seeking inhome childcare. HavenNest will not knowingly discriminate on an unlawful basis or make a referral for an unlawful purpose. HavenNest will make reasonable efforts to verify information supplied by prospective caregivers; however, the Client acknowledges that the Client is directly and ultimately responsible for evaluating candidates and making the final hiring decision.

2. Client Interview and Due Diligence

The Client agrees to personally interview each candidate under consideration and to review the candidate’s qualifications, references, work history, certifications, driving eligibility, and suitability for the family’s specific needs. After a referred candidate accepts the Client’s employment offer and the applicable placement fee is paid, HavenNest will provide the Client with available screening results included in the placement package. Additional screening services may be requested at the Client’s expense.

3. Final Hiring Decision and Assumption of Risk

The Client acknowledges that HavenNest does not guarantee the future conduct, performance, honesty, judgment, or suitability of any referred candidate. HavenNest does not accept responsibility for the Client’s hiring decision or for damages, losses, injuries, theft, property damage, improper care, criminal conduct, negligence, or other wrongful acts or omissions of a caregiver. To the fullest extent permitted by law, the Client agrees to release, defend, indemnify, and hold harmless HavenNest, its owners, employees, contractors, and representatives from claims or liabilities arising from the Client’s selection, employment, supervision, or termination of a referred caregiver, except to the extent caused by HavenNest’s own gross negligence or willful misconduct.

4. Employment Relationship and Employer Responsibilities

HavenNest does not employ the nanny placed with the Client. The employment relationship is directly and exclusively between the Client and the caregiver. The Client is responsible for negotiating and documenting the employment terms and for complying with all applicable federal, state, and local laws concerning wages, overtime, payroll taxes, Social Security and Medicare taxes, tax withholding, workers’ compensation, unemployment insurance, leave, recordkeeping, benefits, workplace safety, and any other employer obligation. HavenNest is not a party to the Client’s employment agreement with the caregiver and is not responsible for administering payroll, taxes, insurance, or benefits unless the Client separately contracts for such services in writing.

5. Placement Fee and Circumvention

A placement fee is earned whenever the Client, a member of the Client’s household, a relative, associate, business, or another family receiving the candidate’s information through the Client hires, employs, retains, or otherwise engages a candidate introduced by HavenNest within twelve (12) months after the most recent referral or introduction. The Client may not avoid the placement fee by changing the candidate’s title, schedule, compensation method, duties, employment classification, or hiring entity.

6. Replacement Policy; No Monetary Refunds

If the employment relationship between the Client and the initially placed candidate ends before the 90th calendar day following the candidate’s start date, HavenNest will conduct one additional candidate search for a replacement, provided that: (a) all fees have been paid in full; (b) the Client promptly notifies HavenNest in writing; (c) the Client provided HavenNest with a completed written nanny-family work agreement; and (d) the position, schedule, compensation, duties, and working conditions remain substantially consistent with those originally presented to the candidate. The replacement benefit does not apply when the position is eliminated, the Client reduces the agreed hours or compensation, the Client relocates outside the service area, insufficient work is available, the caregiver is subjected to unsafe, unreasonable, discriminatory, or unlawful conditions, the Client breaches the employment agreement, or the termination results from circumstances outside HavenNest’s reasonable control. The Client is entitled to one replacement search only. Additional placements are subject to the full placement fee. The Client is responsible for the replacement candidate’s background-screening cost unless HavenNest agrees otherwise in writing. HavenNest does not issue monetary refunds after the candidate search begins.

7. Confidentiality of Candidate Information

All candidate referrals, resumes, profiles, screening information, interview notes, and related materials are confidential and are provided solely for the Client’s evaluation. Candidate information remains the property of HavenNest and may not be copied, published, distributed, posted online, transferred, or disclosed to any other person, family, agency, or business except as required for the Client’s legitimate hiring process. If the Client shares or identifies a referred candidate to another party and that party hires or engages the candidate, the Client will be responsible for the applicable placement fee.

8. Accuracy of Client Information

The Client represents that all information provided to HavenNest regarding the family, children, home, position, duties, schedule, compensation, pets, transportation, travel, safety conditions, and other material terms is accurate and complete. The Client agrees to promptly disclose any material change. HavenNest may suspend or end the search if information is inaccurate, incomplete, misleading, unsafe, discriminatory, or inconsistent with applicable law.

9. Non-Discrimination and Lawful Workplace

The Client agrees to maintain a lawful, respectful, and safe workplace and will not request or make hiring decisions based on any characteristic protected by applicable law. The Client will not ask HavenNest or any candidate to participate in unlawful conduct or perform duties that were not reasonably disclosed during the placement process.

10. Communication and Electronic Records

The Client consents to receiving Agency communications, candidate profiles, invoices, agreements, and notices electronically. Electronic signatures and electronic records will have the same force and effect as original signatures and paper records to the extent permitted by law.

11. Governing Law and Venue

This Agreement will be governed by the laws of the State of Texas, without regard to conflict-of-law principles. Any legal proceeding arising from this Agreement shall be brought in a court of competent jurisdiction located in the Texas county where HavenNest maintains its principal business office, unless the parties agree otherwise in writing or applicable law requires another venue.

12. Entire Agreement; Amendments; Severability

This Agreement, together with any signed fee schedule, invoice, placement confirmation, or written addendum, constitutes the entire agreement between HavenNest and the Client concerning the placement services described here. It supersedes prior oral or written discussions on the same subject. Any amendment must be in writing and signed by both parties. If any provision is determined to be invalid or unenforceable, the remaining provisions will continue in full force and effect.

13. Agency Right to Decline or End Services

HavenNest may decline, pause, or terminate placement services when reasonably necessary, including for nonpayment, abusive or inappropriate conduct, safety concerns, unlawful requests, material misrepresentations, repeated failure to communicate, or conduct that could place a child, caregiver, Client, or HavenNest representative at risk. Termination of services does not eliminate fees already earned or amounts already due.

Client Initials

Date

Payment Authorization and Search Initiation

Please review the payment authorization below before completing this agreement.

A signed Agreement and a $500 search-initiation fee are required before HavenNest begins the candidate search. The search-initiation fee will be applied toward the total placement fee. The remaining balance becomes due when the Client hires, employs, retains, or otherwise engages a candidate referred by HavenNest.

First Name

Last Name

Billing Address (if different from home address)

Billing address is same as home address

Billing Address

Address Line 1

City

State

Zip Code

Preferred Payment Method

Online Invoice / Payment Link

ACH

Check

Other

For security, HavenNest will not request that full payment-card numbers or CVV codes be written on this Agreement. Card payments should be completed through HavenNest’s secure payment processor or payment link.

I acknowledge that I have read and understand the terms of this Agreement. I authorize HavenNest to collect the $500 search-initiation fee and, upon placement, the remaining balance calculated under the Placement Fee Schedule. I understand that the fee includes one standard professional background screening for the selected candidate unless otherwise stated in writing.

Client Agreement

I certify that I have read, understand, and agree to all terms and conditions contained in this Family Placement Service Agreement. I understand that my electronic signature has the same legal effect as my handwritten signature.

Client/Cardholder Printed Name

Client Signature

Date

HavenNest Contact Information

HavenNest Childcare
Dallas–Fort Worth, Texas

Email: [email protected]
Website: www.havennestcare.com