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Families
Inschrijven als familie
Inschrijven als au pair
Host family application form
First name
Name
Nationality
Gender
Selecteer
Male
Female
Require au pair from (country)
Albania
Algeria
Andorra
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroon
Canada
Canary Islands
Chile
China
Colombia
Congo - Democratic Republic
Congo - Republic of
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Finland
France
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Guatemala
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kenya
Kyrgyzstan
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Malta
Mauritius
Mexico
Moldova
Monaco
Mongolia
Morocco
Namibia
Nepal
Netherlands Antilles
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Panama
Paraguay
Peru
Phillipines
Poland
Portugal
Puerto Rico
Romania
Russia
Salvadore
San Marino
Senegal
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Sri Lanka
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
U.K.
U.S.A.
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Zambia
Zimbabwe
Requested start date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Januari
Februari
March
April
May
June
July
August
September
October
November
December
2021
2022
2023
2024
Length of stay
Particulars and expectations - Host family
Name(Contact person)
Postal Address
Postal code / City
Land
Selecteer
Albania
Algeria
Andorra
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroon
Canada
Canary Islands
Chile
China
Colombia
Congo - Democratic Republic
Congo - Republic of
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Finland
France
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Guatemala
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kenya
Kyrgyzstan
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Malta
Mauritius
Mexico
Moldova
Monaco
Mongolia
Morocco
Namibia
Nepal
Netherlands Antilles
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Panama
Paraguay
Peru
Phillipines
Poland
Portugal
Puerto Rico
Romania
Russia
Salvadore
San Marino
Senegal
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Sri Lanka
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
U.K.
U.S.A.
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Zambia
Zimbabwe
Contact host family
Telephone Number home
Telephone Number work
Mobile
Fax number
E-mail
Information Father
Occupation(Host father)
Date of birth(Host father)
/
/
Nationality (Host father)
Selecteer
Albania
Algeria
Andorra
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroon
Canada
Canary Islands
Chile
China
Colombia
Congo - Democratic Republic
Congo - Republic of
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Finland
France
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Guatemala
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kenya
Kyrgyzstan
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Malta
Mauritius
Mexico
Moldova
Monaco
Mongolia
Morocco
Namibia
Nepal
Netherlands Antilles
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Panama
Paraguay
Peru
Phillipines
Poland
Portugal
Puerto Rico
Romania
Russia
Salvadore
San Marino
Senegal
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Sri Lanka
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
U.K.
U.S.A.
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Zambia
Zimbabwe
Information Mother
Occupation(Host Mother)
Date of birth(Host Mother)
/
/
Nationality (Host Mother)
Selecteer
Albania
Algeria
Andorra
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroon
Canada
Canary Islands
Chile
China
Colombia
Congo - Democratic Republic
Congo - Republic of
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Finland
France
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Guatemala
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kenya
Kyrgyzstan
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Malta
Mauritius
Mexico
Moldova
Monaco
Mongolia
Morocco
Namibia
Nepal
Netherlands Antilles
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Panama
Paraguay
Peru
Phillipines
Poland
Portugal
Puerto Rico
Romania
Russia
Salvadore
San Marino
Senegal
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Sri Lanka
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
U.K.
U.S.A.
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Zambia
Zimbabwe
Children (Description of all your children)
Religion
Selecteer
Adventist
African Methodist Episcopal-Zion
Al Qamishli
Alawite
Albanian Orthodox
Anglican
Animist
Armenian Apostolic
Armenian Orthodox
Atheist
Baha'i
Baptist
Brethren
Buddhism
Bulgarian Orthodox
Calvinist
Chondogyo
Christian Orthodox
Church of Christ
Church of Scientology
Confucianism
Congregationalist
Coptic Christian
Daoism
Druze
Eastern Orthodox
Episcopalian
Evangelical Alliance
Evangelical Lutheran
Evangelical Protestant
Evangelist Church
Greek Orthodox
Gregorian-Armenian
Hinduism
Islamic
Jehovah's Witness
Jewish
Kimbanguist
Latter-Day Saints
Lutheran
Mennonite
Methodist
Moravian
Mormon
Muslim
New Apostolic
No Religion
Non-denominational
Pagan Practices
Parsi
Pentecostal
Presbyterian
Protestant
Rastafarian
Roman Catholic
Romanian Orthodox
Russian Orthodox
Seventh Day Adventist
Seventh Day Baptist
Shi'a
Sikh
Taoist
United Free Church
Word of Life
Zoroastrian
Do you have pets?
Yes
No
Hobbies
Primary language spoken in the home
Other language/languages spoken by family members
Number of rooms in the house
Number of bathrooms
Is there any domestic help?
Yes
No
Have you ever had an au pair before?
Yes
No
Do you have children with a disability? (If so, please provide additional information on an extra sheet.)
Yes
No
Do you smoke?
Yes
No
Will you accept an au pair who smokes?
Yes
No
Should the au pair have any special skills (i.e. ability to swim or drive)?
Yes
No
Please describe the au pair?s accommodation
Please list any local language schools
Should the au pair have a driving licence?
Yes
No
Working hours per week
Time-off arrangement for the au pair
Yes
No
Stipend for the au pair
Please list the au pairs holidays
Do you expect the au pair to cook?
Yes
No
Are you willing to pay the au pair?s school/travel expenses?
Yes
No
Job description - Please include any additional expectations or conditions regarding the au pair (i.e. driving licence, household chores, cooking, etc.).
Letter to the au pair
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