Booking Form

What is the name of class you're booking?

When does your class begin?

YYYY

Name

First Name

Last Name

Gender

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell phone

(###)

###

####

Age

The country you're from

When did you arrive in the U.S.?

YYYY

What is your au pair organization?

Who is your au pair counselor/LCC?

First Name

Last Name

What is your au pair counselor/LCC's email?

What is the deadline for fulfilling your educational requirement?

YYYY

Would you like to share your contact details with other au pairs enrolled in the class?

Please add any other information you'd like us to know in the space below.

If I’ve chosen to enroll in a hybrid course: By submitting this form I understand and acknowledge that the course requires me to attend class online as well attend and participate in an in-person learning experience by traveling to the city associated with the course. If I’ve chosen to enroll in a fully in-person course: By submitting this form I understand and acknowledge that the course requires me to attend and participate in classes taking place in the city associated with the course.

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