Marianka Meiring 6 Kwarts Street, Elarduspark, Pretoria Phone Number: (073) 248 30 94 E-Mail: marianka@aupairagency.co.za www.aupairagency.co.za Pet & House Sitting Registration Form Check list for Application: An updated pet care CV. Including references. A copy of your ID. Recent colour photos of yourself with pets. Criminal Record Check (Au Pair Agency s responsibility) Registration Fee R100 Personal details Names & Surname ID no Date of birth (DD/MM/YY) Age: Gender Female Male Languages Email address Cell no Home tell Home address Vehicle (make, model and registration number) Personal Details: Do you smoke? YES NO If you smoke, will you agree not to smoke in the family home / around the pets? Can you swim? YES NO Do you have any allergies? YES NO If YES, please elaborate: YES NO Do you have a criminal record? YES NO If YES, please elaborate:
Pet Care Experience Do you have any Pet & house sitting experience YES NO IF YES how many months/years? What Pets Do You Own? Cats Fish Birds Reptiles Exotic pets Number Breeds What type of animals would you be able to care for Do you have any experience giving Medication to pets Please elaborate: Normal house pets YES Reptiles & exotic pets NO Institute/Family: Period Employed: How many Pets? What type of pets? Job Description: (Duties) References: (pet care) Reference 1 Salary: Contact Person: Contact Number: Institute/Family: Period Employed: How many Pets? What type of pets? Job Description: (Duties) Reference 2 Salary: Contact Person: Contact Number:
Requirements and Expectations Available from until Preferred areas Visits Once a day Twice a day Stay in Maximum number of animals you would be able to take care off Preferred animals to house sit: (please only state those that you have knowledge and experience to take care off) Number Breeds Cats Birds Fish Spiders Chinchillas Bunnies, Guinea pigs, mice, Hamsters Snakes Geckos/ dragons Monkeys Other Reptiles Other Exotic Animals Example: Snakes 2 2 Small dogs: - Sausage dogs, yorkies. - Corn Snakes, Pythons..
Housesitting Duties I am prepared to do the following for my housesitting family and their pets: Feed pets YES NO Give pets Medication YES NO Clean up after pets YES NO Take the pets for a walk YES NO Play with pets YES NO Prepare special food for the pets YES NO Bath pets YES NO Stay Over YES NO Take pets to the groomers YES NO Take pets to the vet in case of an emergency YES NO Cleaning litter boxes YES NO Exotic pets Handle pets (Exotic pets eg. Snakes) YES NO Feed pets YES NO Give pets Medication YES NO Clean up after pets YES NO Play with pets YES NO Prepare special food for the pets YES NO Bath pets YES NO Take pets to vet in case of emergency YES NO Cleaning cages YES NO Cleaning water bowls YES NO Switching lights on & off YES NO House Check that home is secure YES NO Water plants YES NO Perimeter checks daily YES NO Arming of alarm YES NO Electricity checks: fridge, freezer, geyser, pool, etc. YES NO Collecting of post and news papers YES NO Opening closing curtains YES NO Switching lights on and off YES NO Watering plants: in and outdoors YES NO Putting trash out YES NO Other:
Declaration I,, ID no., certify the above to be accurate and truthful and I understand that it is my responsibility to inform AU Pair Agency of any employment, offered to me by persons (and their agents) to whom I have been introduced by AU Pair Agency. I further agree that AU Pair Agency shall negotiate employment on my behalf and that other than my interview with potential employers; I shall not enter into any communication with them until my employment with such family is confirmed by AU Pair Agency or unless agreed upon by AU Pair Agency. Should the family not pay AU Pair Agency the placement fee due, the Au pair agrees to leave the respective family immediately. I agree to the terms and conditions mentioned above Signature: Place: Date: