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

Family Details
Telephone Work Telephone Mobile Telephone
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
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