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Family registration form

Title:
*First name:
*Surname:
*Address:
*Postcode:
*Tel number:
Mobile:
*Email:

Please provide the following personal information:

*Mother’s occupation:
*Father’s occupation:
*Mother’s nationality:
*Father’s nationality:
*Family’s religion:
Do you practice it:
*Spoken language in family home:
*Children’s names and ages:
Are any of the family members disabled:
If yes please specify:
Is a baby expected?
Are you a single parent ?
Do you have pets? If yes please specify:
Do you have any other help (gardener, cleaner, family help)? please specify:
Are you a vegetarian?
Do you smoke?
Family interests:
Anything else you would like to share with us?
*Please provide one reference:

Family requirements

What kink of au pair do you require?
Any preference on nationality
Please specify:
Level of English
Preferred gender of the au pair:
Do you require a driver?
Do you provide a car?
Would you consider a smoker?
Would you accept a vegetarian au pair?
*Duration of stay:
*How many hours per week?
* Pocket money:
Would you be happy to contribute towards English classes costs?
Please specify the au pair's duties (light housework, washing/ironing, tidying, cooking, caring for pets,etc) :
*When would you like the au pair to start?
Have you ever had an au pair?
Anything else you would like to share with the au pair?

Please provide details of your home

* Please describe your home(how many bedrooms ,bathrooms, facilities):
* Please describe the au pair’s accommodation(please include any facilities like Internet, use of computer, tv/dvd in their room, etc) :
* Please describe the area where you live and any amenities:
* I have read and agreed to the Terms & Conditions of business.

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