family name

full address

telephone with full code

(N.B. Your form will be emailed back to you so you can print, sign and post it with all documents)
email address

fax if available

mobile with code

names and ages of brothers/sisters

occupation of mother and father

date of birth

nationality

passport number

date you can arrive?

for how long?

minimum
maximum

do you smoke?

how many a day?

are you willing not to smoke with the family?

do you drive?

date of licence

experience of driving

are you confident/willing to drive in U.K. after some practice?

education

current and previous occupations

level of English (very good | good | fair)

number of years' study of English?

have you got a criminal record?

what age groups of children do you have experience of?
give details here

which age groups do you prefer?

can you do:

cleaning
ironing
simple cooking
washing

do you like/are you used to animals?

which animals?

do you have any allergies, or special dietary wishes?

what are you interested in, in your free time?

please state where you would like to be placed, give as many choices as you can, this makes it easier and quicker to place you, I will do my best. If you are really flexible you will soon be placed.

Don't forget also to ask to be sent all other information, so that you know everything.