Phone/Fax (480)460-1200

PTOFamily Enrollment - Sitter Connection

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 access to our roster of nannies (the best option is access via our web site - if you choose email or fax you will have to contact us each time you would like a new roster):

Which program would you like to enroll in?

Sitter Connection Basic (evening and weekend sitters only) for $115.00
Sitter Connection Expanded (evening and weekend sitters PLUS weekday nannies) for $195.00

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

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

In order to better understand our customers and their needs, please provide a brief description how you intend to use the Sitter Connection pr0gram (how often, days of the week, overnights, etc.) Also, this is the place for any additional notes and comments for the PTOStaff:

To review the Client Terms and Conditions for the Sitter Connection plans.

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 not use the Sitter Connection program for more than an occasional sitter without informing PTO of my intent, receiving their approval and paying any required fees. I will protect the privacy of the nannies on the roster and will not share their information with anyone. In addition, I agree to shred or otherwise destroy the personal information that I receive through this program so that in will not fall into the hands of any one that is not authorized to have it.