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Family Registration Form Please fill this in as accurately and as

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Family Registration Form Please fill this in as accurately and as Powered By Docstoc
					                                   Family Registration Form

Please fill this in as accurately and as honestly as possible. Please mention all the details that
could prove important later on, so that we can find the most suitable and best au pair for your
family.


Name
Address



Tel: (Home)
Mobile:
Work
Fax
Email



MOTHER                                            FATHER
Religion                                          Religion



Nationality                                       Nationality



Profession                                        Profession



Hours of work                                     Hours of work




CHILDREN

Name of child             Age     Sex               School/Nursary Hours         other
Relevant information regarding children e.g. hobbies, interests, special needs, health
problems:




Your Requirements

Have you had an au pair before? Yes            No

Au pair: 25 hours per week: $200 Argentine Pesos minimum

Please indicate level of pocket money:

Does your family follow a special diet? Yes         No

Does anyone in your family smoke?        Yes        No


PREFERRED START DATE:

LENGTH OF STAY:

DAILY WORK HOURS:
          Monday:          From: _____________________ To: ________________________

          Tuesday:         From: _____________________ To: ________________________

          Wednesday:       From: _____________________ To: ________________________

          Thursday:        From: _____________________ To: ________________________

          Friday:          From: _____________________ To: ________________________

          Saturday:        From: _____________________ To: ________________________

          Sunday:          From: _____________________ To: _________________________

Will the au pair be asked to baby-sit in the evenings?   __________________________
If yes, approximately how many evenings per week?

Will the au pair have to work weekends? _____________________________________

if yes, approximately how many weekends per month? _________________________

Will the au pair have his/her meals with the family?

          Morning:         Yes             No

          Lunchtime:       Yes             No

          Evening:         Yes             No

Will the au pair live at the family home: Yes              No


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

Requirements           Yes       No           Maybe   Comments
Driver
Smoker
Vegetarian
Use of car
Use of bicycle
Male au pair
Short term au pair
Long term au pair

Childcare              Yes       No           Maybe   Comments
Bathing children
Changing nappies
Simple cooking
Cooking main meal
ironing
Driving Children
Caring for Pets
Light housework
Grocery shopping


LOCAL FACILITIES

LOCAL FACILITIES
Nearest Airport
Nearest railway station
Nearest Coach station
Nearest language college

OTHER

Will your au pair be treated as part of the
family?
Please give details of any pets


Please list amenities near by



Other useful info
Please describe your au pair’s accommodation:




What time would your au pair be required to start work?




May the au pair use the home telephone? Yes                No

If not, will the au pair be given a pre-paid phone card? Yes           No

Will the au pair be provided with a mobile telephone?     Yes          No

May the au pair use the home computer (internet)?         Yes          No


ABOUT YOUR HOME (Please delete where not applicable)

CITY     TOWN       VILLAGE       RURAL       DETATCHED         SEMI-DETACHED

TERRACED BUNGALOW             FLAT

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 complete and correct in all respects. I understand and am
in full agreement with the Au Pair in Argentina’s Terms and Conditions. I understand that if I fail to
adhere to the Terms and Conditions, the au pair may be removed from my family and I will forfeit
the right to any refunds or credits of any payments I have made.

Signed                                  Date:




Name

				
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Description: Family Registration Form Please fill this in as accurately and as