FAMILY REGISTRATION FORM We apologise for the length of this form but, as you will appreciate, this level of information will greatly assist us to match the best applicant to your requirements. Also e-mail or post 2-3 family pictures (which will be returned). The full application form is also available in MS Word format HERE. You may fill-in the Word document off-line and email to us if you prefer at aupairs4uagency@aol.com. Please note: If you do not agree to our terms, we will be unable to fulfill your requirements. Please select this box: I have read and agree to your terms and conditions FAMILY DETAILS   Mother Father Name Age Occupation Hours of Work Postal Address Home Tel Mobile Tel Fax Work Tel E-Mail Address Marital Status: Please choose: Married Divorced Single Widowed Living With Partner Are you a one parent household? Please choose: Yes No If You Are A Single Parent Please Give Details of 2 Contactable References   Reference No 1 Reference No 2 Name Address Contact Tel No Job Title FAMILY DETAILS CHILDREN: Child 1 Name: Age: Boy/Girl: Please Choose: Boy Girl Child 1's school/nursery hours Child 2 Name: Age: Boy/Girl: Please Choose: Boy Girl Child 2's school/nursery hours Child 3 Name: Age: Boy/Girl: Please Choose: Boy Girl Child 3's school/nursery hours Child 4 Name: Age: Boy/Girl: Please Choose: Boy Girl Child 4's school/nursery hours Child 5 Name: Age: Boy/Girl: Please Choose: Boy Girl Child 5's school/nursery hours Do any of the children have any disabilities or special needs? Please Choose: Yes No If yes, please specify: Are you currently expecting a baby? Please Choose: Yes No Due Date: What is your Ethnic Origin? Mother: Father: What is your Nationality? Mother: Father: Religion: Do you attend Religious Services? Please Choose: Yes No Spoken Languages Has anyone in household ever been convicted of a criminal offence or have any prosecution pending? Please Choose: Yes No Does Anyone in the family smoke? Please Choose: Yes No What are the family hobbies & Interests? Does the family have any special dietary routine? Please Choose: None Vegetarian Vegan Halal Kosher Any other: ABOUT YOUR HOME Where is your house located? Please Choose: London City City Suburb Large Town Small Town Countryside Farm Other Describe your home Nearest Train/Tube Station: Nearest Coach/Bus Stop: Nearest International Airport: Nearest English School: Do you have any pets? Please Choose: Yes No If yes, please specify Do you have any domestic help? Please Choose: Yes No If yes, please specify AU PAIR REQUIREMENTS Are you looking for: Please Choose: Demi Au Pair Au Pair Au Pair Plus Mother's Help Do you want Au pair to be: Please Choose: Male Female Either Start Date? How Long do you wish to engage an Au Pair? What level of spoken English will be acceptable? Please Choose: 1 Basic 2 fair 3 good 4 very good 5 fluent Do You require a driver? Please Choose: Yes No If yes, please specify Would you accept a smoker? Please Choose: Yes No If outside and not around the children Please give details of previous au pairs/nannies or Mother's Help What facilities will be available in Au Pair's bedroom? Will Au Pair be Allowed to attend Language School? Please Choose: Yes No AU PAIR DUTIES Main Duties - please indicate: Getting children ready for school Taking children to school Picking children up from school Helping with homework Children's meals Tidying children's room Bathing children Gardening Looking after pets Ironing Hoover/Dusting Laundry Babysitting Please outline a typical week: Include the time Au Pair needs to be ready & time they finish each day. Also Days off (normally 2) Monday Tuesday Wednesday Thursday Friday Saturday Sunday How many evenings per week will they babysit? Hours of work per week Pocket money per week Any other requirements in respect of the au pair Would you be prepared to assist with the cost of their language course? Please Choose: Yes No Partially Would you be prepared to assist with the travel cost? Please Choose: Yes No Partially Please send me files on the following Au Pairs (Maximum 2) Ref: Ref: How did you hear of Au Pairs 4 U Agency? AGREEMENT: I understand that 'AU PAIRS 4 U AGENCY' is an agency, establishing contact between the Au Pair and me. I agree to the scale of charges and terms of business. AU PAIRS 4 U AGENCY under no circumstances can be held responsible for any loss or damage I may suffer before, during or after the Au Pair's stay with host Family. I understand and accept that an Au Pair introduced to me by AU PAIRS 4 U AGENCY will be treated as a member of my family. I agree to give 2 weeks notice if I should wish to terminate the employment of my au-pair. However, I reserve the right to discharge the employee in the case of finding them dishonest, or having mistreated any member of my family, or any serious misconduct. I have read the above and understood the conditions of AU PAIRS 4 U AGENCY and I declare that the above information is true. Your Name (Compulsory): Your Email Address (Compulsory):    Home | About Us | Information for Families | Family Registration Form | View Au Pairs Information for Au Pairs | Au Pairs Registration Form | Contact © 2003 Au Pairs 4 U Agency