Child Care Solution

FAMILY AU PAIR REGISTRATION

Please fill in the details on this form as completely as possible and click on the SEND button at the bottom.

You must fill in all of the fields on the form. If the question does not apply to you enter 'none' or 'na' in the box.

A) Personal Details

Name:
Address
Home Telephone
Work Telephone
Fax
Email

B) Occupations

Host Father
Host Mother
Hours away from home
Number of adults in household
Names, ages and gender of children
Nationality of family
Religion of family
Do you regularly attend religious services
Main language spoken in the home
Other language spoken

C) Home Details

Type of residence (eg detached, semi, farm, flat):
Location (eg rural, quiet residential, busy residential, main road):
Is your home near a bus/train station:	yes no
Number of bedrooms
Number of bathrooms
Name and address of the nearest language school
Do you have any other domestic help
Do you have any pets

D) Au Pair Details

Date Required from:
Date Required to:
Preferred nationalities:
Non-smoker: (Au pairs who smoke will be asked to sign an agreement whereby they do not smoke in the house)	Essential Preferred Unconcerned
Car Driver	Essential Preffered Unconcerned
Will a car be available for the Au Pair:	for duty and leisure duty only no
Any other special requirements or information that you feel would assist us in selecting the most suitable Au Pair for your family
Pocket money to be paid per week (minimum £45):
Free days (minimum 2):
Accomodation available for Au Pair:
Will the Au Pair be treated as a member of the family, joining you in the evenings and for meals:

E) Time Table of Au Pair Duties

Please state how you would expect your Au Pair to spend a typical day, remembering that they will not expect to work for more than 5 hours per day and must be allowed time off during school hours to attend English classes.

Morning
Afternoon
Evening
Baby Sitting (max 2 evenings per week)
Have you ever used theChildcareSolution or WorldNetUK before:	yes
How did you hear of us:

F) Please give the name, address and occupations of two persons (not related to you), to whom we may write for a reference.

Referee1
Referee2
Do you wish to take out the Au Pair Insurance package:

The completing and submitting of this form will be deemed as an acceptance of our family terms and conditions