1.  I, _________________________________________, confirm that I have read all written materials provided by the au pair agency in my home country and my host country and that I fulfill all criteria.  I understand that the au pair programme is a cultural exchange programme and not a contract of work.  I am aware that being an au pair requires a high degree of both responsibility and flexibility and that I must take my duties seriously.

2.  I confirm that I have answered all questions honestly and that all information in the application is true.

3.  After confirmation of placement, I shall stay in touch with my host family adn shall inform them of my travel arrangements.  I agree not to travel to my host family until I have received an official confirmation of placementfrom the au pair agency.

4. I shall familiarise myself with all (if any) visa requirements.  I shall obtain necessary documents (e.g. a valid passport) prior to departure and shall not enter my host country without a proper visa (if required).

5. I agree to cover all costs for language courses, travel to and from my host country (unless otherwise stated in the programme guidelines) and any debts incurred (e.g. telephone bills, etc).  I shall bring emergency funds with me (depending on the host country the au pair agency will recommend the minimum amount of monies) to pay for unforseen expenses.

6.  I am familiar with and agree to abide by all programme guidelines and conditions, in particular those regarding: the number and distribution of working hours, au pair duties, pocket money, free time, holidays, language courses, transportation costs, insurance and the termination of an au pair arrangement.

7.  Upon arrival in my host country, I shall discuss in detail with my host family the daily or weekly routine and my and their expectations of the au pair programme.

8.   understand that my childcare duties are of prime importance and I shall carry them out responsibly in a caring and considerate manner.

9.  I understand that I shall be asked to undertake light household duties and to make a fair contribution to the cleanliness of the "common" areas of my host family's home and I agree to keep my own room clean and tidy.

10.   I shall seek the advice of the host family before administering any form of discipline on the children.  Under no circumstances shall I hit the children or leave them alone.

11.  I agree to abide by all house rules set by the host family (e.g. use of telephone and facilities within the home, daytime and overnight visitors, curfew, smoking, etc.).  During my stay I shall behave in a manner which does not reflect badly upon my host family, the au pair agency or my home country.

12.  I shall discuss and agree my free time arrangements with my host family well in advance.

13.  I shall make a concerted effort to experience the culture of my host country and to learn the language.  I shall respect cultural differences and display tolerance towards others.

14.  I shall make every effort to resolve any differences with my host family if I have any problems or questions which cannot be discussed and resolved with the host family, I shall contact the au pair agency in my host country for assistance in accordance with the procedures advised by the au pair agency.

15.  If no solution can be reached and I have to leave the host family, I understand that a notice period must be respected and observed in accordance with program guidelines.  During this time period, I shall perform my normal duties and I shall continue to receive room, board and pocket money.

16.  If a new host family placement is found for me, I understand that this may involve moving to a different area.

17.  I understand that I shall be expelled from the programme without compensation and under certain circumstances may have to return home if:

• I fail to abide by this agreement or programme guidelines
• I falsify any information in my application (e.g., regarding smoking, child care experience, health, etc)
• I begin my au pair stay before receiving an official confirmation of placement from the au pair agency or a proper visa
• I administer corporal punishment to a child
• I am responsible for repeated problems with several host families
• I disobey the laws of my host country

18.  I agree to leave my host country before my visa or residency permit expires (if applicable).

19.  I shall not undertake any other paid employment and will perform only those tasks related   to the au pair programme.

20. I shall notify the au pair agency immediately if there are any changes to the information included in my application.

21. Should I decide to cancel my application, I shall inform the au pair agency at once.

22. I understand that as a participant of an Au Pair Cultural Exchange Programme I shall behave in a responsible manner and respect cultural differences.

Date: ___________________________ 

Signature: _______________________    Print name: ______________________________