Parent Registration Form/ Au Pair Request

First Choice Nanny Agency Ltd. Middlegate Cottage, Ratcliffe on Soar Nottingham, NG11 0EB Telephone: 01509 670758 / 07830 081 721 Email: [email protected]

Parent Registration Form/ Au Pair Request (completing this form confirms that you have read and accept our terms and conditions)

Parent’s details Surname: Mothers name: Mother’s date of birth: Mother’s Profession:

Fathers name: Father’s date of birth: Father’s Profession:

Address 1: Address 2: Town/city: Postcode:

Telephone no: Mobile no: Fax no: e-mail address:

Religion: Ethnic Origin: Nationality: Language spoken by family:

First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb Children’s Details

Childs name Age Gender and details

Do any of the children have special needs? If yes please provide details:

Please give a brief description about yourselves and your family (personalities, interests, aims, etc):

Details regarding your Au Pair:

Would you prefer:  Male  Female  No preference

Would you prefer a non-smoker? Is smoking permitted in the house? Is smoking permitted outside the house?

Would you be able to cater for a vegetarian?

Would you prefer an Au Pair that can swim?

Would you prefer an Au pair that can drive?

Do you have any preference regarding the age of your Au Pair?

Have you had an Au Pair before?

When would you like your Au pair to start?

First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb For how long do you wish to have an Au pair?

Do you have any preference regarding the nationality of your Au Pair? If yes please give details:

Please give a brief statement explaining why an Au pair should come and stay with your family:

 Au Pair facilities

Please indicate which of the following facilities the Au Pair will have access to:  Own bedroom  Own bathroom  Own television  Internet  Other Please give details:

 Au Pair Duties

What days off will the Au Pair have?

How many evenings will the Au Pair be expected to work?

How many hours per day will the Au Pair be expected to work?

What pocket money will you provide (per week)?

How much will you pay for any extra hours worked (per hour)?  Day:  Evening:

Please give details of any duties you will expect the Au pair to carry out:

First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb Please give details of anything else you feel to be relevant in helping us to find you the most suitable Au Pair:

Your Home (Please see the check list – we try to get photographs of the home, area and family if possible)

Do you have a:  Detached house  Semi-detached house  Flat  Other- please specify:

Number of bedrooms?

What is your nearest town/city?

How long does it take to get there?

Is there a means of getting there by public transport?

Please give details:

What is the nearest language school? Distance?

Do you have any other domestic help? Please give details:

Do you have any pets? Please give details:

Do you or anyone else in the household smoke?

Please give a description of the surrounding area (e.g. is it a village, town or city? Is it a busy or quiet area? Local attractions? Anything else which might be relevant to your au pair?

First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb