On-Line Registration Form

Fields Marked with a * are required
Contact Name (Full Name):
Email:
Telephone (Landline):
Mobile:
Have you had an au pair before?:
Number of children?:
Home Location (Postcode/ name village/town/city):
Type of home location:
Is Driving Required:
What is your view about smoking?:
Would you consider a male au pair?:
What age au pair would you be comfortable with??: Please select...
 Any age (not important)
 17 - 18
 19 - 20
 21- 23
 24 - 25
 26 - 30
 31 - 40
 41 - 50
 51+
Comments - Considerations - Special Requests:
Date Au Pair is required by: None
Do you have pets?: Please select all that apply...
 Birds
 Cats
 Dogs
 Horses
 Indoor small animals (Hamsters, mice etc.)
 Outdoor small animals (Rabbits, guinea pigs etc.)
 Tropical fish
 Other
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