Name
 **Family     **Given      Other

**Street

**Postal Number **City **Country

**Home Phone Other Phone

**Easiest time to reach me

E-mail address

**Date of birth Citizenship

**Earliest month I can depart **Latest month I can depart

Present year of study/ occupation

Certificates / university degress attained

Driver's License Yes No Smoker Yes No

Spoken English fluent good fair poor

How did you hear about EurAupair?

**Experience with children over 2 years old:

**Experience with infants and children under 2 years old:

Do you have 2 years of full time child care experience? No Yes

Do you have a degree in Education or certificate in infant/child care? No Yes

Please send a brochure to my friend:

Name
 Family     Given      Other

Street

Postal Number City Country

Home Phone E-mail address