Midland Au Pairs - Host family registration

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FAMILY REGISTRATION FORM

Please complete this form with as much detail as you can, as this will help us to find au pairs that closely match your requirements. Please include a photo, which must be in JPEG of GIF format and less than 400kb in size. You can always send additional details/ photo after registration via our e-mail address.

CONTACT DETAILS
First name
Last name
E-Mail
Re-enter E-Mail
Address
Telephone
Mobile
PARENTS
		Mother:		Father:
Full name
Address if different to above
Marital status
Nationality
Religion
Profession
Hours of work
Age
CHILDREN
	Name:			:Age:	Gender :
Child 1
Child 2
Child 3
Child 4
Children's interests/ hobbies
Children's health problems/ needs
AU PAIR REQUIREMENTS
Preferred start date		dd	mm	year
Minimum placement duration
Maximum placement duration
Working hours required
Level of pocket money you will pay
Describe duties required
How often will babysitting by required
What days will the au pair have off
Driving au pair required
Swimmer required
Will you accept a smoker
Will you accept a vegetarian
Will you accept a male au pair
Please detail any additional incentives, e.g. holidays, help with travel fares, tuition, use of car
LOCAL FACILITIES
Nearest airport
Nearest railway station
Nearest coach station
Nearest language college
Please list amenities nearby
ACCOMODATION
Location
Housing
Number of bedrooms
Number of bathrooms
Reception rooms
Do you have any pets, please detail
Will the au pair have own bedroom
Own bathroom
Own TV
Access to internet
Please describe any other relevant information about your home
Will you collect the au pair on arrival in the UK
How did you hear about Midland Au Pairs
UPLOAD FAMILY PHOTO
Insert photo
AGREEMENT
I have read and agree with Midland Au Pairs Terms and Conditions*

		*Click here to read our Terms and Conditions>>