Phone/Fax (480)460-1200

PTOFamily Enrollment - Hot Jobs!

Please fill out the following information so that we may process your order. When complete, press the 'submit' button, you will then be taken to a secure Credit Card processor to finish the payment process. If you prefer, you can call the office with your credit card and have us process the payment for you. In either case, you must complete this page first.

Please provide the following information for the parent that is to be our primary contact:

First Name		Last Name
Street Address		City
State		Zip Code
N/S Cross Street		E/W Cross Street
Home Phone		Home Fax
Employer Name		Work Phone
Work Fax
Driver's License #
E-mail (cannot be blank, use a 'dummy' address if necessary)

Please provide the following contact information for your spouse (if applicable):

First Name		Last Name
Employer		Work Phone
Fax		E-mail

Please provide the name and date of birth for each of your children:

Name:

Date of Birth:

Please provide the following payment information (we use only a secured server to process your payment information). However, if you prefer, you may enter a number here of '999999999' and then call, email or fax (480-460-1200) our office with your billing information.

	BILLING
Cardholder Name
Card Number
Card Type		Expiration

Choose one of the following options for us to send profiles to you:

Please tell us how you heard about Parent's Time-Out:

Name of Nanny, Friend, Co-worker, etc. Referral(s):

Additional Notes and Comments for PTOStaff:

To review the Client Terms and Conditions for Hot Jobs!

I have read the Client Terms and Conditions and I accept the terms and conditions.

In particular (but not excluding the full contract) - I will protect the privacy of the applicants and will not share their information with anyone. In addition I agree to shred or otherwise destroy all personal information so that it will not fall into the hands of any one that is not authorized to have it.

Check our company’s
ratings at Angie’s List.

(480) 460-1200
Fax: (480) 460-1200
Email Us!

We are proud to be members of the following professional organizations:

International Nanny Association (INA)
National Association of Nannies (NAN)
Better Business Bureau
National Association for the
Education of Young Children (NAEYC)
Arizona Association for the Gifted and Talented

Privacy Statement: We will NOT share your information with ANYONE!

Created by: Access by Design,
1999-2007

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