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E-mail

Password

Password Confirmation

Family Information

Family's Last Name

Community Administator Name

Are you a single parent?

Location and Contact Information

Address

City

State

Zip

Phone

Mobile

Other Information

What primary language is spoken at home?

What other language(s) do family members speak?

When would you like the Au Pair to arrive?

Are you a U.S. citizen?

Are you a permanent resident?

Do you wish to 让你安排等候的互惠生来看你的寄宿家庭 profile?

How many children 需要付钱就好了?

Does your child 要求互惠生有专门的处理背景特殊需求，挑战和/或任何医疗状况?

How did you find out about CHI Au Pair?

If you were referred 若要前往CHI互惠生，请输入个人或机构名称 who referred you to us:

If you have been in 联系CHI Au - Pair销售和安置协调员，请输入他们的信息 code:

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Pre-Arranged Au Pair

In which Au Pair 你有想法了?

Is this an arranged 会有一个特殊的孩子?

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