Request form for families

Dear families

By means of this form we will try to find an au pair young lady who will suit you and avoid misunderstandings. The information which you provide will not be publicly available but posted on a password protected domain to which only interested young ladies will have access. The names and addresses will not be visible and will only be communicated only to a young lady interested in a particular family.

Please check all applicable boxes.

I. Contact information




Country SwitzerlandFranceCanadaUSAOther:




II. Family

For what reason(s) are you looking for an au pair?

What languages do you speak? Your children?

How many children do you have?

What age are your children?

Situations and particular difficulties
We ask you to indicate any eventual situations or particular difficulties in your family. This information will be used simply to avoid having an au pair who is overwhelmed and who interrupts her stay for that reason.

Do you have domestic animals? (in case an au pair has an allergy)



III. Your expectations and wishes

For what period of time would you like to have an au pair as a guest?
From to
What minimum time would the au pair have to stay (for example, one month)?

You expect the young lady to be present:

occasionally from time to time (for example, only for evenings / only during the week and not on weekends etc.)continually (with a few eventual exceptions for trips/outings/shopping/studies)

What activities and responsibilities would you like to entrust to the young lady? Describe briefly please.

Religious conviction
What degree of religious conviction do you expect of her? Describe briefly please.

What can you offer to the young lady?
Lodging, food, family outings, etc.Other (for example: pocket money, etc.):

Would you be prepared to help the young lady learn a language?
YesNoI would like to have a conversation with her first, to get to know what level she is at.It would be possible to attend language classes in a nearby school.


IV. Relations with the Society of Saint Pius X

Will the young lady be able to attend Sunday Mass at a Society of Saint Pius X Mass centre?
YesNo. Please describe your situation.

At which Society priory or chapel do you attend Mass?

Who is the priest in charge of this priory or chapel?

Please give the contact information of another priest if you do not wish to use the priest named above as your reference.


V. Remarks

Thank you for the time you have given to filling out this form. Is there any additional information you wish to give us? Do you need any more information?

I confirm that I have answered these questions honestly and I agree that part of this information be published in a protected domain. I agree also that my name and address be given to a young lady who has shown interest.