Tutor-Aupair-DemiPair-Nanny
cultural exchange program inquiry
Name and surname
Name
Surname
E-mail
*
phone number
*
-
Date of birth
*
-
Mese/month
-
day
year
Date Picker Icon
GENDER
*
male
female
CITIZENSHIP
*
SMOKER
*
yes
no
DRIVER
*
yes
no
WHAT COUNTRY DO YOU WANT TO GO
*
CAN YOU SWIM
*
yes
no
CHILDCARE EXPERIENCE
*
YES
NO
Summarise your overall experience with children, please
WHAT IS YOUR RELIGION , PLEASE?
PROGRAM TYPE
*
home english tutor, only for English mother tongue
au pair
demi pair attending language classes
nanny
Other
EARLIEST START DATE
*
PROGRAM LENGHT
*
45 DAYS -for English or German mother tongues-
UP 2 MONTHS
90 DAYS
4 MONTHS
6/8 MONTHS
12 MONTHS
IS YOUR CRIMINAL RECOPRD EMPTY?
*
yes
no
Studies performed
Do you have any current/pre- existing medical conditions?
*
yes
no
Do you have any allergies (include pets)?
*
yes
no
Are you currently taking any medication
*
yes
no
Are you currently receiving , or have you received, any psychiatric or psycholog ical treatment?
*
yes
no
are you on particular diet?
*
yes
no
Would you agree to undergoing a test for aids/HIV?
yes
no
Family Preference
CAN YOU ACCEPT A SINGLE PARENT?
yes
no
only with a single mother
WITH A DIFFERENT RELIGIOUS BELIEFS TO YOU?
yes
no
WITH A CHILD WITH DISABILITIES?
yes
no
MANY FAMILIES HAVE PETS , CAN YOU CACCEPT LIVING WITH
dog
cat
RABBIT
COULD YOU CONSIDER TO SHARE OCCASIONALLY YOUR ROOM WITH THE CHILDREN ?
yes
no
YOU HAVE EXPERINCE WITH
looking after children aged 0-2
looking after children aged 3-7
looking after children aged 8-12
looking after disabled children
keeping children occupied (play with them)
doing light housework
washing/ironing clothes
cooking simple meals
looking after pets
CAN YOU DRIVE FOR THE FAMILY ?
*
yes
no
Please leave some notes can be usefull to your host family
I agree with the Privacy Policy of this site
YES
Invia
Should be Empty: