Host Family and Au Pair of the Year Contest (Combined Entry)

Host Family and Au Pair of the Year Submission Form
Host Parent 1

First NameLast Name
Host Parent 2

First NameLast Name
Host Family's Email
example@example.com
Host Family's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Host Child(ren) Name(s)
Au Pair

First NameLast Name
Au Pair's Email
example@example.com
Au Pair's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Au Pair Arrival Date in the Host Family's Home

MonthDayYear
Date
Submissions
Video Submission Upload

Cancelof
Written Submission: Host Family

0/800
Written Submission: Au Pair

0/800
PHOTOS

Please share high quality photos for your submission (no collages please).

We will not post any photos of your host children publicly without the host parent's permission. Each host family needs to fill out this form for any children in the photos/video:

Click here to complete the photo/video release form
Please include at least 5 photos with your submission
Cancelof
I consent to the use of my nomination, including photograph(s) by representatives of Agent Au Pair, Inc. and their affiliates, employees, officers and agents to educate the public about our intercultural childcare program. The essay and photos may be included in the following media: the Agent Au Pair website, Agent Au Pair blog, social media posts on Instagram, Facebook, twitter, etc.
Should be Empty:

Host Family and Au Pair of the Year Submission Form