Apply as a host family

Apply here as a Host Family

Family composition

Family / Home / Private environment

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Host family information

Host Mother : First Name

Host Mother : Last Name

Host Father : First Name

Host Father : Last Name

Civil Status

Host Mother : Date of Birth

Host Father : Date of Birth

Host Mother : Place of Birth

Host Father : Place of Birth

Host Mother : Nationality

Host Mother : Nationality

Host Mother : Occupation

Host Father : Occupation


Postal Code



Host Mother : Phone

Host Father : Phone

Host Mother : Email

Host Father : Email

Host Mother : Skype ID

Host Father : Skype ID

Family description

How many children do you have ?

Name - Age



Name - Age



Name - Age



Name - Age



Is there a baby expected ?

Additional information about your children

Do you have any disabled children or children with a handicap ?

Do your children attend school/kindergarten ?

What is the school's name ?

What is the school's address ?

What is the kindergarten’s name ?

What is the kindergarten's address ?

Family / Home / Private environment

Description of your home

Number of bedrooms

Number of bathrooms

Description of your location

Are you close to public transportation ?

Are you close to recreation area ?

Distance between your home and closest recreation/city center

Which is the closest city near your home ?

Is there anyone for cleaning (weekly) ?

Did you have an au pair before ?

Who has taken care of the children before the arrival of your au pair ?

What is your religious affiliation ?

Do you practice your religion ?

Which languages do you speak at home ?

What other languages do you know ?

Do you have pets ?

Do you or your family members smoke ?

Please list your family’s hobbies

You declare that you are aware that it is legally required

to provide a separate bedroom for your future au pair

to subscribe for an insurance for medical, hosiptalisation and repatriation costs

to enroll your future au pair for language courses (FR - NL - GE)

Can you provide the following to your future au pair (not legally required) ?

a separate bathroom

internet access

a separate personal computer

a car to borrow

Additional expectations concerning your future au pair

Do you expect the au pair to be able to drive a car ?

Would you accept an au pair who smokes ?

Do you have any preference for any particular nationality ?

In which language will you communicate with the au pair ?

Are there any preferential languages you want to speak with the au pair ?

Please state when the au pair can take off (besides the obligatory 1 day per week, 1 weekend per month, 1 week per 6 months)

Would you allow your au pair to stay outside your house during weekends ?

Do you expect the au pair to travel with you ?

What duties will the au pair have in charge ?

Newborn care

Feeding baby


General tidying

Assisting with homework

Washing clothes

Dusting and vacuuming


Shopping for food

Bring children to school

Bathing children

General tidying


Ironing clothes

Taking care of pets

Other ( please specify )

What type of au pair would suit your family ?

Relevant answers

Costs - Comments - Validation

You declare that you are aware that the minimum monthly allowance for the au pair is 450 € in Belgium

Do you wish to pay the au pair more allowance ?

Reimburse ratio %

To which degree, if at all, will you reimburse the transport costs of the au pair (airplane/train ticket) form/to home/host country. If you do reimburse the transport costs, they can only be deducted from the monthly allowance if the au pair accepts it in writing.

Your additional comments (house rules, expectations, special skills, etc)

We declare that the information provided in this application form is true and correct. We also agree that any uncorrect or false answer may lead to a cancellation of the Au Pair Program and will allow the au pair to leave our family and ask reimbursement of all costs made by him/her in respect of his/her placement as an au pair in our family and that we will comply with the legal provisions regarding au pairs in Belgium