Kidz Au Pair Agency

Family Registration Form By Post

If you prefer you can Download and Print out the form, please send completed forms to:

Kidz Au Pair Ltd.,
Passage West,
Cork, Ireland.

Family Registration Form By Fax

Fax to +353-21-4841905

Also we ask you to enclose two passport size photographs with application.

Download PDF form now

Family Registration Form

Name

Address

Country

Telephone (Home)

Telephone (Mobile)

Telephone (Work)

Email Address

Wife's occupation

Full or part time

Husband's occupation

Full or part time

Family nationality

Family religion

Languages spoken

Additional Details

Names of Children	Age	At Playschool, School or Home?

Is a new baby expected

Medical conditions / disabilities

Is the family vegetarian

Family hobbies / interests

Give details of any pets

Does anyone smoke

HOUSE DETAILS

House Type

Number of Bedrooms

Number of Bathrooms

Garden

Location

Nearest Town or City

Distances in KM to

Town

Bus Stop

Shops

Train Station

Language School

Cinema

FAMILY REFERENCE
Please provide details of a person, or a previous Au Pair that can provide a reference for your family.

Name

Address

Telephone Number

Relationship to your family

Your Au Pair PREFERENCES

When do you want them to start

For how long do you want them?

months

Nationality Preferred

Would you accept a Smoker?

Would you accept a Vegetarian?

Would you accept a Male Au Pair?

Do you require a Driver?

Is a Driver Essential?

Confirm that the Au Pair can attend Language School

Have you ever had an Au Pair before?

Accommodation for your Au Pair

Confirm that the Au Pair will have their own room

What facilities will the Au Pair have in their room

	Bathroom
	TV
	Radio/Cassette
	Desk

Duties required from your Au Pair

Confirm the Au Pair will have 2 full days off per week

No of evenings babysitting (up to a max of 2)

Hours per week

Pocket Money per week

Do you employ other helpers?

Au Pair List of Duties

Any Other Information Relevant

By checking this tick box, I / We accept and agree to abide by the Kidz au pair agency terms and conditions of business. (July 2007). Whic I / we have read and understood. I / we confirm that the information provided in our application form is correct and accurate. I / we shall also notify Kidz Au Pair immediately if there are changes to the information in our application form