Host Family Registration Form to apply for an Au Pair

Family Name           Fathers Name 
        Mothers Name       

Full Address 

including Post Code

Telephone
Fax          
E-mail      
Religion Nationality
Mothers' Occupation Father's    
Occupation
Place of Work, fax and telephone No.
Type of House No. of Bedrooms

Au Pairs accommodation

Own TV?

Own Room?
Will the room be heated? 

Name(s) and Age(s)  Children 
Is a baby expected
Do you employ Domestic Help? 

Do you have any pets?  
 
Will the au pair be expected to help
 with these pets ?

Nearest Transport 
Nearest Shops 
Nearest College
 
Details of Language Classes and cost     
Average working hours -        Per Day   Per Week     Days off 
Duties Expected of Au Pair    
Number of Evenings Baby-Sitting
When do you require an Au Pair? 
For how long ?                             		Will you accept a smoker        
Will you accept a male Au Pair  

Do you require a driver?      Do you require a swimmer?    

 

Will you collect from Airport/Station    Please state nearest to you

    Pocket money (not less than £(current rate) per week)   

A separate letter outlining duties and a family photograph would be ideal for the Au Pair.

Please give name and address of a person who can provide a family reference
           

Have you engaged an au pair before?

   If yes, how many? 
Nationality preferred?  1.   2.      3. 
How did you hear about us? 
I hereby certify that the information given in the above form is correct and that I have read
  and understood the Agency Terms and agree to abide by them.
Signed            Date  

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