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Date Au Pair needed* MM JanFebMarAprMayJunJulAugSepOctNovDec YYYY 200820092010 Have you ever used live-in child care?* Please Select YesNo Current Child Care* Please Select Au pairBabysitterDay Care CenterFamily Day CareFamily MemberHousekeeperIn SchoolMaternity LeaveNannyNursery SchoolPregnant Number of Children* Do you have a child under two years of age?* Please Select YesNo Household Type Please Select Dual Working CoupleSingle FatherSingle MotherWork Home BothWork Home FatherWork Home Mother	Questions or comments:
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