Surname

Forename

Address

Home Phone

Office Phone

Mobile Phone

Fax Phone

E-mail Address

Occupation (Wife/Partner)

Occupation (Husband/Partner)

Nationality and Religion (Wife/Partner)

Nationality and Religion (Husband/Partner)

Children's Name, Age and Sex

Family Hobbies/Interests

Family Pets

Type of Au-Pair

Regular Plus Mother's Help

Length of Stay

Weekly Pocket Money to be Paid

Describe your Home (# of rooms, etc.)

Describe au-pair's accommodation (own room / own bath / TV)

Nearest Airport

Nearest Underground

Nearest British Rail Station

Nearest Language College

Start Date

Preferred Nationality

Would you like to tell us anything else that would help us find you a suitable au-pair?

Terms & Conditions for Families

Please read the following and then sign.

Terms & Conditions for Families: (1) These terms and conditions of business are between Sunflower Au-Pair & Mothers Help Agency (hereinafter called the Agency) and the Client. The Agency will only undertake business on the terms and conditions contained herein. No variation of the terms will be valid unless confirmed in writing by the Agency. The Client shall be the person who has signed the agreement on the application form. (2) The Agency acts as agents for the purpose of effecting introductions between Clients and Au-pairs and the fees to the Agency are for introduction only. The Agency cannot be held responsible should the Au-pair stay for a shorter time than that agreed with the Client. (3) Although the Agency takes every care to check the applicant’s details, the Client is strongly advised to satisfy himself/herself as to the suitability of the applicant. (4) The Agency does not accept responsibility for any loss or damage resulting from the Agency’s introduction or provision of services or from any acts, omissions or conduct of staff introduced by the Agency. (5) The request by the Client to the Agency to supply details of an applicant will be deemed to be acceptance of the Agency’s terms and conditions. (6) If the applicant fails to arrive, or leaves within the first 14 days, the Agency will offer a substitute within 14 days of being notified in writing. If no replacement is available after this period, the fee will be refunded less £50 administration charges. If the Client decides, FOR WHATEVER REASON, not to accept the replacement no refund shall be due to the Client. No refund is available if the Client finds an applicant from another source before the expiry of the aforesaid 14 days. Refunds will only be made provided the Client notifies the Agency IN WRITING WITHIN 5 DAYS of termination of employment and the Agency’s invoice has been paid in full within 7 days of the invoice date. (7) All applicants are entitled to one week’s notice of termination of employment. Failure to comply with this condition results in automatic loss of right to refund, replacement or credit. However, in the event of serious misconduct by the Au-pair or the host family (Client), either party shall be entitled to terminate the engagement immediately. If the Au-pair’s departure is as a result of misconduct on the part of the Client the Agency has no obligation to replace the Au-pair or offer any refund of fees. (8) Au-pairs must be paid a minimum of £50 per week and an Au-pair Plus a minimum of £60 per week. (9) If the Client directly or indirectly introduces an applicant to any other family or employer the Client will be liable for the full fees should the applicant be engaged. (10) If the Client decides not to accept the applicant after an invoice has been raised no refund will be made. A credit for a period of 3 months from the invoice date will given. Once a Client has accepted an applicant and an invoice has been raised following this acceptance, the Client is liable to pay the full amount stated on the invoice. (11) In all cases if a substitute is offered by the Agency and refused by the Client no refund or credit is due. (12) The Client must pay the applicable placement fee on acceptance of the applicant. If the fee is not received within 7 days, an additional fee of £35 will be added to the placement fee. Cheques should be made payable to 'Sunflower Agency'. (13) Although every effort is made to ensure that any information given to a Client is correct, the Agency cannot be held responsible for any incorrect information. (14) Submission of an application form to the the Agency constitutes agreement to the above terms and conditions.

I, (please state your full name), have read, understood and accepted the "Terms & Conditions for Families": (please tick)