First Name

Last Name

Email Address

Phone Number

Postal Address

Skype ID / Video Call Details

Child / Childrens’ Details

Special Requirement for Children

Children’s Favourite Hobbies(crafts, painting, sports etc.)

Profession of Parent/s

Name of nearest town/city to your house?

Distance from your home to the town / city centre?

Is there public transportation from your house to the town/city centre?

How far is the nearest bus stop?

How frequent is the bus service to the town/city centre?

Closest town / village with English classes?

Are there other known au pairs in the area?

How much payment will you offer your au pair weekly?

Will there be additional hours?

Have you previously hosted an au pair in your home?

Preferred start date?

Length of placement?

Do you smoke?

Would you accept an au pair that smokes?

Should your au pair hold a driving licence?

Will you provide a car?

Is yes, can the au pair use it on their free days?

Typical schedule for your au pair?

Total weekly hours?

Do you have any pets? If so, which pets do you have?

Do you want the au pair to care for them?

Should your au pair have any special skills (e.g. swimming or horse riding)?

What is the primary spoken language in your family?

What expectations do you have of the au pair placement?