FAMILY
REGISTRATION
Type of Au Pair required?
Au Pair
Mothers Help
Au Pair plus
Family Name
First Name(s)
Address
Town
County
Post Code
Nationality
Your Religion
Home Phone
Mobile Phone
Fax
Email Address
Details of Children
What will be the Au Pair's duties?
How much are you prepared
to pay the Au Pair?
Au Pair can smoke?
Don't Mind
No
Not in house
Au Pair to drive?
Yes
No
Doesn't matter
Preferred Gender?
Female
Male
Either
Preferred start date
Length of stay
Further information or
message to Au Pair?