Inscription

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Student Details

Surname:

First name:

Date of birth:

Gender:

Nationality:

Address:

Telephone:

Mobile:

Email address:

Parent's phone number:

(in case of emergencies)

Parents' occupations:

Number of brothers and sisters(with ages):

Study Information

Details of current study:

For how many years have you studied English?

Fluency in English:

How many times have you been to England before?

Have you been an 'au pair' or 'aide-maman' before?

If so, please give the name, address and telephone number of the family you stayed with so we can contact them for a reference:

About you

Do you smoke?

Have you a driving licence?

Can you swim?

Interests and pastimes:

Maintenez appuyé "Contrôle (ctrl)", ou "Commande (touche pomme)" sur un Mac, pour en sélectionner plusieurs.

Other activities or relevant information:

About this stay

What age group would you prefer to work with?

As a summer holiday au pair are you prepared to help with:

Basic cooking
Light housework
Washing & Ironing

Preferred dates: from:

Preferred dates: to:

Number of weeks:

Possible start date:

Possible end date:

Files

Scanned reference from english teacher:

Letter of motivation:

Terms and Conditions

I have read and understood the terms and conditions.