Au Pair Registration Form first name:       last name:      Male Female Email:     nationality: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComoros Costa RicaCôte dIvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFrance GabonGambiaGeorgiaGermanyGhanaGreeceGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelJamaicaJapanJordanKazakhstanKenyaKiribati Korea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritania MauritiusMexicoMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeru PhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychelles Sierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSuriname SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguay UzbekistanVanuatuVatican CityVenezuelaVietnamWeb DirectoriesWestern SaharaYemenZambiaZimbabwe address:  address:  address:  post/zip code:  country: ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComoros Costa RicaCôte dIvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFrance GabonGambiaGeorgiaGermanyGhanaGreeceGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelJamaicaJapanJordanKazakhstanKenyaKiribati Korea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritania MauritiusMexicoMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeru PhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychelles Sierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSuriname SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguay UzbekistanVanuatuVatican CityVenezuelaVietnamWeb DirectoriesWestern SaharaYemenZambiaZimbabwe telephone: mobile: date of birth:      status:  ---singlemarriedcohabitingdivorced     english:  ---LittleFairGoodVery GoodFluent education - please give details: Do you wish to attend English classes in the UK?   Yes No activities driver drive UK smoker vegetarian cinema reading sport art science theatre walking countryside riding city life swimmer   availability available from:  latest availability  shortest stay ---6 weeks2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months 1 year longest stay ---6 weeks2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 months13 months14 months15 months16 months17 months18 months19 months20 months21 months22 months23 months24 months25 months26 months27 months28 months29 months30 months31 months32 months33 months34 months35 months36 months37 months38 months39 months40 months41 months42 months43 months44 months45 months46 months47 months48 months aupair aupair plus rural village town city duties maximum children  ---123456     age of children 0 - 4  Yes No nappies  Yes No age of children 5 - 12  Yes No feeding baby  Yes No dressing  Yes No putting to bed  Yes No housework  Yes No washing up  Yes No laundry  Yes No ironing  Yes No making beds  Yes No simple cooking  Yes No shopping  Yes No gardening  Yes No pets  Yes No occupy children  Yes No experience   Yes No special needs:  Yes No Please provide additional information to support your application (e.g. experience, interests, why want to be an Au Pair etc.)    Please provide details of your hobbies: Do you have any allergies? Yes No   If yes please provide details:   Please provide details of who to contact in an emergency: Have you contacted other agencies? Yes No     How many?   If yes please provide details:   How did you hear of us? web advertsing friend through UK family other   Please provide comments or any other information that will help us to select the best Family for you. You may upload up to 1 photograph, for a total of 2000000 bytes. The pictures should be no more than 400pixels wide and be in a .jpg format Upload photograph click browse to select: I agree to the terms and conditions   Yes No