Parent #1
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First Name
Last Name
Email Parent #1
*
Phone Parent #1
*
Country
(###)
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Occupation Parent #1
*
Parent #2
First Name
Last Name
Email Parent #2
Occupation Parent #2
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Skype / Whatapp
What is your preferred start date for your Au Pair?
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MM
DD
YYYY
What is your latest start date for your Au Pair?
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MM
DD
YYYY
What length of stay are you looking for in an Au Pair?
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Click all that apply
Please list all children's names, date of birth & gender
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Please describe your family's favorite activities & hobbies
Do any of the children require special medical attention or have a disability?
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Have you hosted an Au Pair before?
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Would you prefer:
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Do you require your Au Pair to drive?
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Would your Au Pair have access to a car for personal use?
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Do you require your Au Pair to swim?
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How many hours per week would you like your Au Pair to work?
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This can be an estimate, tick all that apply
What would be the Au Pairs main duties?
*
Do you have a private bedroom for your Au Pair?
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This is a requirement—your Au Pair must have a private space to retreat to. It cannot be a home study or any other shared area.
Please provide a brief description of the Au Pair's bedroom
Do you have a private bathroom for your Au Pair?
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This it not a requirement
Please describe your home and the area/suburb you live in, including the distance to public transport.
Do you have any pets?
*
Will you accept an Au Pair who is Vegetarian or Vegan?
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Yes, they do not need to cook meat
Yes, but I still require them to cook meat for the children.
Yes, we are a vegetarian or vegan family
No thank you
Reference
*
Please provide the name and email address of someone who has known you for over 12 months, is not a relative & can provide a character reference for your family.
Are there any court orders, parenting orders, or parenting plans in place regarding the powers, duties, responsibilities, or authority of any person in relation to the child/children or access to them?
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I understand that we are required to provide a current Police Check before an Au Pair can be placed with us
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This is required for everyone aged 18+ living in your home.
I have read & understood the terms and conditions on this website
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While every care is taken in introducing Au Pairs to families, the agency is not responsible for any problems arising from information that is provided as incorrect and I accept the conditions of this agency. I hereby declare that the information is given on this form and the enclosed documents are true in every respect.
Date
MM
DD
YYYY
