Client Survey

FAMILY INFORMATION

Give us some information about you and your family.

Main Contact Name

First Last

Home Phone

Work Phone

Cell Phone

Adults in the House

Adult's Name

Relationship

Male or Female

Birthday

Occupation

Commute (Drive,Bus,Train)

Children in the House

First Name

Male or Female

Age

Birthday

Grade in School

Pet Needs

Boarding

Breeder

Groomer

Pet Supplies

Playgroup

Sitter

Veterinarian

Walker

Religious Affilliation

Jewish

Christian

Buddist

Hindu

Other

Additional Comments on your Family

YOUR HOMES

Tell us where you live and where you're moving to.

Your Current Address

Street Address

Address Line 2

City

State

ZIP Code

Where You're Moving To

Street Address

Address Line 2

City

State

ZIP Code

When Do You Expect to Move to Your New Home?

Already Moved?

Check here if you're already in your new home

Services For Your New Home

Interior Needs

Anything Else We Should Know About Your Homes?

WHAT ARE THE MALE ADULTS INTERESTED IN?

Tell us about the adults in your house

First Name

Sports Activities

Working Out

Would you like an at Home Personal Trainer?

Work out in a Gym?

Work out at Home?

Hobbies

Personal Grooming

Beard trimming

Facial

Hair

Manicure

Massage

Pedicure

Shave

Waxing

Apparel

Casual

Formal

Professional

Is there second Adult Male in the house?

Yes

ANYTHING ELSE WE SHOULD KNOW ABOUT THE ADULT MALES?

WHAT ARE THE FEMALE ADULTS INTERESTED IN?

Tell us about the adults in your house

First Name

Sports Activities

Working Out

Would you like an at Home Personal Trainer?

Work out in a Gym?

Work out at Home?

Hobbies

Personal Grooming

Hair Care

Blowout

Color

Cut

Extensions

Apparel

Is there a second Adult Female in the House?

Yes

ANYTHING ELSEWE SHOULD KNOW ABOUT THE ADULT FEMALES?

WHAT ARE THE KIDS INTERESTED IN?

Tell us about your kids' interests

Name

Sex

Female

Male

Age

School Preference

Public

Private

Home School

Additional School Preferences

Catholic

Jewish

Non-Denominational

Special Needs

Check the subjects for Tutors

English

History

Math

Science

Reading

Spanish

French

Japanese

SAT/ACT

Teacher Preference

Male

Female

Either

Tutor Preference

Home Tutoring

Go to a Tutoring Center

Do you need a College Consultant?

Yes, I need a College Consultant

Do you need a Driving Instructor?

Yes, I need a driving instructor

Nursery School Recommendations

Full Day

Half Day

At Home Child Care

Au Pair

Baby Nurse

Babysitter

Doula

Nanny

I'm interested in Summer Camp

Day Camp

Local / Recreational

Overnight Camp

Travel Camp

Special Needs

Tell Us More About Your Summer Camp Needs

I'm interested in Children's Grooming

Hair

Nails

Threading

Skincare

Waxing

I'm interested in Children's Clothing

Check all that apply

I'm interested in these Teams for my child

Individual instruction

Town/rec leagues

Travel leagues

I need Dance Classes for my Child

Avant Garde

Ballet

Ballroom

Jazz

Modern

Tap

Musical Instruments

Music Services

I need a store to purchase/rent instruments and accessories

I prefer lessons in my home

I prefer lessons outside the home

I'm interested in these Groups for my child

Book Club

Boy Scouts

Brownies

Choir

Cub Scouts

Girl Scouts

Mommy and Me

Religious Groups

Theater

I'm interested in Party-related services

Is there a Second Child in the House?

Yes

ANYTHING ELSE WE SHOULD KNOW ABOUT THE KIDS?

SENIOR CITIZENS

Tell us about Senior Citizens in your house