I would like to host an au-pair* only in July and August from September to June all year round

Name(s)*

Family name*

Address:*

Occupation(s)*

Mobile phone number(s)*

Home phone number

Email*

Confirm Email*

Nationality*

Names and ages of children*

Are there any other people living in the family home?*   YES NO
If YES, give details here.

Please tell us about the accommodation you can offer your au-pair* single room in the family home double room in the family home other

If OTHER, please give details here

Will the student(s) have an en-suite room or exclusive use of a bathroom?*  YES NO
If YES, give details here.

Are there any pets in your home?*  YES NO
If YES, give details here.

Does anybody in the family smoke?*   YES NO
If YES, is smoking permitted inside your home?

Does anybody in the family speak a foreign language?*  YES NO
If YES, give details here

Does any family member have any special needs (medical, dietary, behavioural, etc)?*  YES NO
If YES, give details here

Has the family hosted an au-pair before?*  YES NO
If YES, give details here

Mark the activities you are interested in*.
football   television   reading   basketball   cinema   travelling   tennis  
theatre   water sports   cycling   music   video games   swimming   IT  
photography   golf   clubbing   horse-riding   walking   dancing   art

Please give details of any other hobbies and interests you or your family have here:

Please give details of what you expect your childcare requirements to be.

If you live in a rural area, can you transport or provide transport for your au-pair to and from her English classes?*
YES NO N/A

If you live in Dundalk, do you live within a 30-minute walk of the school?*  YES NO N/A

If you live in a rural area, is your home on a bus route?*   YES NO N/A
If YES, give details here

I have read the terms and conditions for hosting an au-pair*