Name
Address
Tel (Home)
Mobile
Work
Fax
Email
Mother
Religion
Nationality
Profession
Hours of work
Father
Religion
Nationality
Profession
Hours of work
Children

Name of Child	Age	Sex	School/Nursery Hours
		Male Female
		Male Female
		Male Female
		Male Female
Relevant information regarding children e.g. hobbies, interests, special needs, health problems
Have you had an Au Pair before?   YesNo
Your Requirements
Au Pair 25 hours £70 per week min Au Pair Plus Up to 35 Hours £80 min EU Nationals only.
	How much pocket money will you pay (Pounds)
Preferred start date:(DD/MM/YYYY)
Length of stay: (Months)
Please include any other details which may assist us in finding the best match for your family, also any additional incentives for example holidays, use of car, paid phone calls, help with travel fares and college fees, local activities and places of interest.
Please list any other help employed i.e. nanny/cleaner/gardener etc:

Requirements	Options	Comments
Driver?	YesNoMaybe
Smoker?	YesNoMaybe
Vegetarian?	YesNoMaybe
Use of car?	YesNoMaybe
Use of bicycle	YesNoMaybe
Male au pair?	YesNoMaybe
Short term au pair?	YesNoMaybe
ChildcareSimple CookingDriving Children Bathing ChildrenCooking Main MealCaring for Pets Changing NappiesIroningLight Housework WashingBabysitting EveningsGrocery Shopping

Nearest airport
Nearest railway station
Nearest coach station
Nearest language college
Will your au pair be treated as part of the family?  YesNo
Please give details of any pets
Please list amenities nearby
Please describe your au pairs accommodation
What time would your au pair be required to start work
About Your Home
Location   CityTownVillageRural
Type   DetatchedSemi-detachedTerracedBungalowFlat
Please describe your home and accommodation for example number of bedrooms, bathrooms, facilities such as dishwasher, swimming pool, domestic help etc.
Briefly describe your family for example, active/busy/noisy/quiet, hobbies, interests, likes/dislikes
How did you hear about our Agency?
Declaration
I certify that all the above information is correct. I understand and am in full agreement with the Terms and Conditions of Business of Angel Au Pairs and I agree to provide the conditions as shown on my completed Family Registration form. I understand that if I fail to adhere to the Terms of Business, the au pair may be moved from my family and I will forfeit the right to any refunds or credits of any payments I have made.