The Childcare Company - au pair service registration form

Complete this form if you want to register for our au pair service.

Family Details
Name
Address
Postcode
Telephone	Home Telephone	Work Telephone	Mobile Telephone
Telephone
email
Mother's Occupation		Father's Occupation
Hours mother away from home each day		Hours father away from home each day
How many adults live in your household?		Ages and gender of children
Religion of family		Do you regularly attend religious services
Main language spoken in the home		Other languages spoken
Home Details
Type of Residence (e.g. detached, farm, flat)		Location (e.g. city, town, village)
Is your home near a bus/train station?		How far are the shops from your home?
Number of bedrooms		Number of bathrooms
Please give name and address of nearest Language School		How far is the nearest language school from your home?
Do you have any other domestic help?		Do you have any pets
Specific Requirements
Required	Required from (DD/MM/YYYY)	Required to (DD/MM/YYYY)	Months required for
Required
Non Smoker		(Au pairs who smoke will be asked to sign an agreement whereby they do not smoke in the house.)
Car Driver
Will a car be available for the au pair/childcarer from overseas?
Brief description of your au pair's daily routine (include no of hours of childcare, housework, laundry and ironing)
Weekly Payment
Free Time
Accommodation Available
Any other information you feel may assist in selecting the most suitable au pair for your family
Have you ever used the agency before?		How did you hear of us?
Agreement
I/We have read and accept your Terms & Conditions. I/we will treat any information regarding applicants as confidential and will return all forms and paperwork required regarding a placement by the date stated in the terms of business.

The Childcare Company - Au Pair and Nanny Agency, 7 Garth Road, Sevenoaks, Kent TN13 1RT