Host Family Registration Form

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Thank you for your interest in working with Culture Online! It is our pleasure to help you find the right candidate. Please fill in this registration form and our team will guide you through all the steps involved in the program. We will be in touch with you for us to understand your expectations in hosting an Au Pair and also, we would like to get to know more about your family.

Email *

First Name *

Last Name *

Contact Mobile Number *

Contact Email Address *

Video/Web Conferencing Contact Info *

Please provide preferred platform for Au Pair Initial Talk (Skype ID, Zoom, WhatsApp)

Living Address *

Street, House Number, Post Code

Are you married? *

Yes

I'm in a registered partnership

I am a single parent

Other:

What are your professions? *

What is your nationality? *

What is the main language spoken in your home? *

What is your religion or spiritual practice? *

None

Other:

Do you or your partner smoke? *

Yes

Do you have pets at home? *

If Yes, Please specify at others

None

Other:

Have you hosted an Au Pair before? *

Yes

Other:

We have found our own Au Pair *

Yes

Do you have a preference on the nationality of the Au Pair you would like to host? If you do, please provide us with the nationalities and provide a reason for your preference. *

Please list the number, gender and ages of your children : *

Do any of your children require special care? *

Are the Host Parents in good health condition? *

Yes

Other:

Does anyone in your family have any allergies? If your answer is yes, please provide more details. *

What activities would you like your Au Pair to do with the children? *

Play with them at home

Prepare the children to get dressed for the day

Prepare the children's breakfast

Take the children out to play

Take the children to and from school

Take the children to and from after-school activities

Go swimming with them

Go biking with them

Other:

Required

Please select all the traits that best describe your family. *

Spontaneous - does not spend much time or effort in planning activities in advance

Organized - prefers to have all activities planned and scheduled in advance

Adventurous - prefer to explore and try new things

Conservative - prefers to do things that you are familiar or comfortable with

Assertive - prefer to openly express yourself, and your thoughts and opinions

Passive - prefers to keep your thoughts and opinions to yourself

Outgoing / Extrovert - prefers to go out, and meet new people

Reserved / Introvert – prefers to keep to yourself, enjoy alone time or smaller groups

Flexible - okay with making changes and adjustments as needed

Rigid - prefers to stick to an established schedule/routine and dislikes making changes

Creative - prefer to think out of the box and be imaginative in solving problems

Logical - prefers to solve problems by being rational; decisions are well thought out and calculated

Direct - prefers to be straight-forward, even if it may lead to an argument or disagreement

Non-confrontational - avoids speaking up to avoid arguments and disagreements

Energetic - has high energy; is always on the move and doing something

Calm - prefers everything to be slow-paced; is disciplined and thoughtful with your actions

Firm - prefers to be authoritative and have a disciplined environment; prefers things to be done your way with little negotiation

Gentle - open for discussions and is democratic on discipline and requests

Serious - be a parental figure to the Au Pair

Fun-loving - friendly relationship with the Au Pair

Other:

Required

Please select the traits that you DO NOT want in an Au Pair. *