Questionario Family

Fill out the form below to submit your Host Family request and we will get back to you as soon as possible.

Family Parents

Family parent #1

Name

Surname

Family parent #1 Phone

Family Parent #1 Email

Family Parent #1 Profession

Family Parent #1 Religion

Family parent #1 Nationality

Family Parent #1 Age

Family parent #2

Name

Surname

Family parent #2 Phone

Family Parent #2 Email

Family Parent #2 Profession

Family Parent #2 Religion

Family parent #2 Nationality

Family Parent #2 Age

Au Pair Preference

Male

Female

Indifferent

Living Address

Address

Number

City

State/Province/Region

Postal Code

Country

Name, age and sex of all children

Any special needs?

Yes

No

Please explain needs

What languages are spoken at home?

Family hobbies and interests

Any specific family dietary information?

New baby expected?

Yes

No

Does any member of the household smoke?

Yes

No

Is your family in good health?

Yes

No

Please, specify health problem

Other House Persons?

Yes

No

Who?

Do you have pets at home?

Yes

No

Which?

Do you wish your applicant to care for your pets?

Yes

No

Type of House

What is your location like?

Do you employ domestic staff?

Yes

No

Please indicate hours

Please indicate how essential it is for you to have a clean and tidy home?

Nearest Train Station Distance

Nearest Bus Routes Distance

Nearest Airport

Single bedroom?

Yes

No

Private bathroom?

Yes

No

Use of Internet?

Yes

No

Weekly Pocket Money provided?

Yes

No

Is there a language school nearby?

Yes

No

Weekly wage per week?

Room Description

Childcare Duties

Childcare Skills

Household Duties

Required Starting Date

Length of stay (months)

Hours on duty per week (to include babysitting)

Average babysitting evenings per week

Free days

Other benefits

Preferred applicant

Will you accept a smoker?

Yes

No

Driver required?

Yes

No

Have you had live-in help before?

Yes

No

Previous Applicant Information

Description of what you expect from your au pair/Tutor

Description of our family

Family Letter

Photo

Choose File

Name

Surname

Company name

Address if different from the home address

Address

Number

City

State/Province/Region

Postal Code

Country

P.IVA or Tax ID code

Terms

* Accept the terms

I consent to this website storing the information I submit so they can respond to my inquiry.

While every care is taken in introducing families, the agency is not responsible for any problems arising. I have Read all the information and accept the conditions of this agency. I hereby declare that the information given on this form and the enclosed documents are true in every respect.