AU PAIR REGISTRATION
About You First name Surname Date of Birth Address in UK Town County Post Code Mobile Phone Daytime Phone Evening Phone Fax Email Address Country / Nationality Other Languages Qualifications What are you presently doing? Level of English Beginner Average Good Very Good Have you been an Au Pair before? Yes No Father's Profession Mother's Profession Details of Brothers & Sisters Your Religion When do you want to start? How long do you want to stay? Your Personality Active Flexible Enthusiastic Adaptable Polite Open Minded Friendly Reliable Punctual Optimistic Responsible Shy Are you allergic to anything? Do you smoke? Yes No Sometimes Do you like pets? Yes No Some Are you vegetarian? Yes No Hobbies & Interests Visa Aerobics Biking Fitness Jogging Football Volleyball Rollerblading Tennis Cooking Painting Reading Skiing Hiking Swimming Horse Riding Dancing Theatre Cinema Sight Seeing Computers What kind of visa do you have? Valid until: Driving Do you hold a valid driving license? Yes No Are you comfortable driving in the UK? Yes No Maybe Childcare Can you organise activities for children? Yes No Some How did you hear of Hampstead Aupair Agency? Are you patient with small children? Yes No Sometimes Can you command children's respect? Yes No Sometimes General Are you able to assist with these general duties? Care for Babies Care for Newborn Care for Older Children Babysitting Caring for pets Light Housework Cooking Washing Ironing Do you have a special message you would like to pass on to host families? I declare that all the information on this form is true and agree to inform Hampstead Au Pair Agency of any changes. I agree to Hampstead Au Pair Agency’s terms & conditions.