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Name:
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E-mail address:
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Confirm e-mail address:
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Please choose a colour scheme for your new website (see above for choices):
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Home address:
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Do want your home address to be placed on your website?
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Yes
No
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Home telephone no:
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Hours of work (i.e. 7am - 6pm):
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If you pick-up and drop-off at schools or nurseries etc, please give details:
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What are you hourly fees? Are meals/pick-ups/drop-offs included etc?
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If you visit toddler groups or play groups please give details:
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Do you have a garden? If so please give details stating any play equipment etc:
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If you have any pets please give details:
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Do you have public liability? If so, who is it with?
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Do you use a car for your childcare business?
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Yes
No
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Are you a non-smoking household?
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Yes
No
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Please give details of any fire security measures, for example, smoke alarms on all floors, fire blankets, extinguishes etc:
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Please give details of any current qualifications and/or cetificates such as first aid etc:
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How long have you worked as a childminder?
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Would you like to be called a 'childminder', 'childcare provider' or other?
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Have you had any previous experience working with children? Please give details:
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Would you like a free guestbook placed in your website? This allows people visiting your site to leave their comments (you have full editing control)?
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Yes
No
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By checking this box you indicate that you have read the FAQ:
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Yes
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Would you like the search engine submission package priced at £30?
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Yes
No
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What is your prefered method of payment?
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PayPal
Cheque
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Please add any other details in this box (larger text or images can be sent to me via e-mail):
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Do you already own a domain name that you would like me to use?
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Yes
No
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If answer to above is yes, please give details. If answer to above is no, what would be your prefered domain name, assuming it is available (i.e. www.yoursite.co.uk)?
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Do you want to keep your current e-mail address on your new site or use a brand new one relating to your domain name (i.e. info@yoursite.co.uk)?
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Keep current e-mail address
Use a new e-mail address
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Finally, how did you hear about this website?
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