Family Registration Form
Print Form and fill it Offline
Fill Form and send it Online
Please print off and complete both parts of the Family Registration and return it (by post or e-mail) together with 1 signed copy of the Agency's Terms, a family photograph and £20 Registration Fee to Bergerac Agency's Address.
*Family Details*
*Family Requirements*
Start date:
Earliest: Latest:
Length of stay:
Nationality: Age:
SEX: female / male / couple
VEGETARIAN: essential / preferred / unconcerned
NON-SMOKER: essential / preferred / unconcerned
DRIVER: essential / preferred / unconcerned
Other preferences:
Au-Pair's Accommodation:
Will you provide the Au-Pair with their own:
Television: Car:
Radio / CD Player: Bicycle:
Internet access at home:
*Timetable of Duties*
Please describe how you would expect your Au-Pair to spend a typical day:
Start at: Luch at: Finish at:
Morning Duties:
Afternoon Duties:
Total working hours:
Per Day: Per Week:
Evening baby sitting: Free days:
Free time daily: Pocket money weekly:
If the Au-Pair's parents require a reference, please give a name and address of someone who has known you personally for a period of at least 2 years:
SIGNATURE: …………………………………………
DATE: …………………………………………
*Family Details*
Surname:
First Name:
Wife:
Marital Status:
Age Husband:
Wife:
Address:
Home Tel:
Work Tel:
Mobile:
E-Mail:
Husband:
Occupation:
Religion:
Nationality:
Ethnic Origin:
Smoker:
Wife:
Occupation:
Religion:
Nationality:
Ethnic Origin:
Smoker:
Any other languages spoken in your home:
Name of children:
Date of birth:
Sex:
Age:
Name of children:
Date of birth:
Sex:
Age:
Is new baby expected:
Disabilities / Handicaps:
Pets:
Hobbies:
Do you have any domestic help / what type:
Accommodation:
Type:
No. of bedrooms: No. of bathrooms:
Toilets: Garden:
Type of area:
Where / how far is / are the nearest:
College (for English classes):
Town: Shop:
Bus / Train:
*Family Requirements*
Start date:
Earliest: Latest:
Length of stay:
Nationality: Age:
SEX:
female
male
couple
VEGETARIAN:
essential
preferred
unconcerned
NON-SMOKER:
essential
preferred
unconcerned
DRIVER:
essential
preferred
unconcerned
Other preferences:
Au-Pair's Accommodation:
Will you provide the Au-Pair with their own:
Television: Car:
Radio / CD Player: Bicycle:
Internet access at home:
*Timetable of Duties*
Please describe how you would expect your Au-Pair to spend a typical day:
Start at: Luch at: Finish at:
Morning Duties:
Afternoon Duties:
Total working hours:
Per Day: Per Week:
Evening baby sitting: Free days:
Free time daily: Pocket money weekly:
If the Au-Pair's parents require a reference, please give a name and address of someone who has known you personally for a period of at least 2 years:
SIGNATURE: …………………………………………
DATE: …………………………………………
Submit Form