Apply as a host family "*" indicates required fields Contact detailsName* First name* E-mail* Mobile*Family compositionNumber of childrenPlease enter a number from 1 to 8.Boy(s)Please enter a number from 0 to 4.Girl(s)Please enter a number from 0 to 4.AgeYour future au pairDriving licence required? yes No Preference for a specific nationality? Yes No If so, which nationality? Preference for a specific language? Yes No If so, which language? TasksBabysittingyesNoSometimesBabysitting during the weekendyesNoSometimesBabysitting during the eveningyesNoSometimesAssistance with homeworkyesNoSometimesDriving the children to activities / schoolyesNonSometimesCooking a simple mealyesNonSometimesBathing childrenyesNonSometimesFeeding a babyyesNonSometimesShopping for foodYesNoSometimesMaking the bedsYesNoSometimesIroningYesNoSometimesEmpty the dishwasherYesNoSometimesTidy upyesNoSometimesCleaning the kitchenyesNoSometimesTaking the dog for walkyesNoSometimesOthers?Additional comments (house rules, expectations, special skills, etc.)Confirmation / ValidationWe declare that the information provided in this application form is true and correct. Any incorrect or false answers may result in the cancellation of the registration. We will comply with the legal provisions concerning au pairs in Belgium* Yes, the information provided in this application form is true and correct. PhoneThis field is for validation purposes and should be left unchanged.
