urrey Au-pair Agency - Family application Form
Surrey Au-pair Agency - The right match..                      Call us on: 01483 532 106
                            FAMILY APPLICATION FORM
 
PLEASE REGISTER AS A HOST FAMILY
 £25.00 
 
           
             PLEASE FILL IN AND SEND YOUR APPLICATION FORM
 
YOUR APPLICATION WILL BE CONSIDERED VALID ONLY IF IT IS SENT TOGETHER WITH THE REGISTRATION FEE! OUR AUTOMATED SYSTEM LINKS PAYMENTS TO THE APPROPRIATE APPLICATION FORM. DUE TO TIME CONSTRAINTS WE CAN NOT RESPOND TO INVALID APPLICATIONS.
 
Mother's Name
Mother's Occupation
Father's Name
Father's Occupation
Would you like?
An Au-pair
An Au-pair Plus
A Mother/Father's Help
An Au-pair Couple
Would you consider a male Au-pair?
Yes
No
I have no preference
Home Number ( please include area code)
Work Number (please include area code)
Emergency Contact Number (please include area code)
E-mail Address
Number of children
Chilren's names,ages and interests
Family's Nationality
Family's Religion (please tell us whether you practice your religion)
Family's spoken language (please note: by law,au-pairs can only be placed into families whose main spoken language is English).
Tell us about your Family (please include hobbies and interests,any relevant medical conditions,allergies and dietary requirements,etc)
No. of adults living in Family's home
Is your home?
In the country
In a village
In a town/city
Please describe the Family home
Will you provide your Au-pair with her/his own bedroom?
Will you provide your Au-pair with her/his own bathroom?
Yes
No
He/She will share with the children
Any other extras you provide for your Au-pair?( TV,HI-FI,internet,bicycle, use of a car,etc)
Is a car driver Au-pair essential?
Yes
No
I have no preference
Available public transport in your area
Name and distance to nearest station?
Distance to children's School/Nursery (from family home)
Have you ever had an Au-pair before (if so,please give us a brief description of your experience)
Your Au-pair's duties and responsibilities
How many hours would the Au-pair work?
Amount of pocket money offered
Please give details about your Au-pair's free time
Do you or any other member of your Family smoke?
Is a non-smoking Au-pair essential?
Yes
No
Would you accept a vegetarian Au-pair?
Yes
No
I have no preference
Do you employ the help of any domestic staff?( is so,please give details)
Do you have pets?(if so,please give details of number and type of pets)
Is there any other information you would like to share with us?
When yould you like your Au-pair to start?
I require my Au-pair to stay for (please provide length of time in month)
Name
Date
I have read,understood and accepted Surrey Au-pair Agency's Terms&Conditions of Business
I agree
 YOU SHOULD RECEIVE A CONFIRMATION MESSAGE AFTER SENDING THIS FORM !