House o Orange: Basic Family Registration

If you're interested in hosting an au pair or a nanny through House O Orange Au Pairs, we would strongly urge you to fill in and submit this form.
(Questions with a * are mandatory).

Family name: *
Family nationality: *
Address: *
City: *
Country: *
Daytime phone number: *
Daytime phone number: *
Current e-mail address: *
I'm interested in: *
From: month/year *
Until: month/year *
The au pair/nanny must speak the following language well: *
The au pair/nanny must have a basic command of the following language:
Would you consider a male au pair/nanny?
What type of au pair/nanny personality would you feel most comfortable with (i.e. outgoing, active, independent, quiet, reserved etc.)?
What age would you prefer your au pair/nanny to have?
Please list the number, gender and ages of children: *
Are you hoping to have another child during the period that you require an au pair/nanny?
Do your children have any special needs?
If yes, please specify:
Will the au pair/nanny be required to do housework? *
If yes, please specify no. of hrs per day and type of housework required:
How many hours of help do you require per week? *
Do any members of your family smoke?
If yes, please specify:
Will you accept an au pair/nanny *
Will your au pair/nanny be required to drive? *
Should your au pair/nanny have any special skills (i.e. swimming, horseback riding, skiing, etc.)?
If yes, please specify:
Will your au pair/nanny be expected to travel with you?
If yes, please specify:
Have you had an au pair or a nanny before?
If yes, please specify:

Please submit your form now.