<p> First Choice Nanny Agency Ltd. Middlegate Cottage, Ratcliffe on Soar Nottingham, NG11 0EB Telephone: 01509 670758 / 07830 081 721 Email: [email protected]</p><p>Parent Registration Form/ Au Pair Request (completing this form confirms that you have read and accept our terms and conditions)</p><p>Parent’s details Surname: Mothers name: Mother’s date of birth: Mother’s Profession:</p><p>Fathers name: Father’s date of birth: Father’s Profession:</p><p>Address 1: Address 2: Town/city: Postcode:</p><p>Telephone no: Mobile no: Fax no: e-mail address:</p><p>Religion: Ethnic Origin: Nationality: Language spoken by family:</p><p>First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb Children’s Details</p><p>Childs name Age Gender and details </p><p>Do any of the children have special needs? If yes please provide details:</p><p>Please give a brief description about yourselves and your family (personalities, interests, aims, etc):</p><p>Details regarding your Au Pair:</p><p>Would you prefer:  Male  Female  No preference</p><p>Would you prefer a non-smoker? Is smoking permitted in the house? Is smoking permitted outside the house?</p><p>Would you be able to cater for a vegetarian?</p><p>Would you prefer an Au Pair that can swim?</p><p>Would you prefer an Au pair that can drive?</p><p>Do you have any preference regarding the age of your Au Pair?</p><p>Have you had an Au Pair before?</p><p>When would you like your Au pair to start?</p><p>First Choice Nanny Agency Ltd. Registered in England – 6134927 Director - K Weston – Webb For how long do you wish to have an Au pair?</p><p>Do you have any preference regarding the nationality of your Au Pair? If yes please give details:</p><p>Please give a brief statement explaining why an Au pair should come and stay with your family:</p><p> Au Pair facilities</p><p>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:</p><p> Au Pair Duties</p><p>What days off will the Au Pair have?</p><p>How many evenings will the Au Pair be expected to work?</p><p>How many hours per day will the Au Pair be expected to work?</p><p>What pocket money will you provide (per week)?</p><p>How much will you pay for any extra hours worked (per hour)?  Day:  Evening:</p><p>Please give details of any duties you will expect the Au pair to carry out:</p><p>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:</p><p>Your Home (Please see the check list – we try to get photographs of the home, area and family if possible)</p><p>Do you have a:  Detached house  Semi-detached house  Flat  Other- please specify:</p><p>Number of bedrooms?</p><p>What is your nearest town/city?</p><p>How long does it take to get there?</p><p>Is there a means of getting there by public transport? </p><p>Please give details:</p><p>What is the nearest language school? Distance?</p><p>Do you have any other domestic help? Please give details:</p><p>Do you have any pets? Please give details:</p><p>Do you or anyone else in the household smoke?</p><p>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?</p><p>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</p>