Host Family Contact Form
Please complete this form if you are a host family.
Employment
Category:
*
Au Pair
Au Pair Plus
Mother's Help
Nanny
Housekeeper
Companion
Live-In Couple
Title:
Mr.
Mrs.
Miss
Dr.
Prof.
Lord
Lady
First Name:
*
Surname:
*
Address:
*
Town:
*
County:
Country:
*
Select Country
Australia
Belgium
Canada
Denmark
France
Germany
Holland
Iceland
Italy
Norway
New Zealand
Spain
Switzerland
United Kingdom
United States
Post Code:
*
Telephone No.
(Home):
Mobile:
Work:
E-mail address:
*
Starting date
required:
*
How many children:
*
1
2
3
4
5
6
7
8
Children Age/Gender
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Age:
*
Gender:
*
M
F
Driver Required:
Yes
No
Smoker accepted:
Yes
No
Out of house
Pets:
Any further information:
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