Sample Host Family and Au Pair Agreement –

Massachusetts Addendum
The information contained in this Addendum and the attached sample agreement are intended to provide general guidance to assist
host families and au pairs so that they may satisfy their mutual obligations under the Massachusetts Domestic Workers Bill of Rights Act
(“MDWBORA”) to memorialize the terms and conditions of the placement in a written agreement. It does not, and is not intended to,
constitute legal advice. Instead, the information is provided for general informational purposes only.

Host families and au pairs may utilize the following sample or a different agreement in a form of their choosing, including, but not limited to,
the agreement provided by the Attorney General’s office (link is located on your host family portal). Host families and au pairs should negotiate
and note mutually acceptable terms. Host families and au pairs are solely responsible for ensuring that their agreement satisfies all
legal requirements, including those contained in MDWBORA and the Department of State (“DOS”) Au Pair Program regulations.

The Kids in Care Book* may be used to outline your weekly schedule, hours, and childcare assistance responsibilities. If you do use this book,
you must include the weekly schedule (including meal/rest breaks and off duty times), hours, and childcare assistance responsibilities in this
agreement. Host families and au pairs must maintain weekly time sheets and sign them each week to acknowledge the accuracy of hours
worked.

Host Family Name:____________________________________

Host Family Address:________________________________________________________________________________________

Host Family Phone Number:____________________________

Child Name, Age, Gender:___________________________________________________________________________________

Child Name, Age, Gender:___________________________________________________________________________________

Child Name, Age, Gender:___________________________________________________________________________________

Au Pair Name: _______________________________________

Match Start Date:____________________________________ Match End Date:_______________________________________

*The Kids in Care Book was included in your match confirmation packet. To request another, please email
Massachusetts@aupairinamerica.com with Subject line Kids in Care. Please include your host family ID and last name. Thank you.

Massachusetts Addendum APIA2020

Please initial each section to show agreement.

Compensation:
A minimum stipend of $195.75 per week regardless of how many hours of childcare assistance the au pair provides in that week
(up to the DOS regulatory maximum of 10 hours per day and 45 hours per week).

Please consult the Massachusetts Minimum Wage Table:

Effective Date Minimum Wage

January 1, 2020 $12.75
January 1, 2021 $13.50
January 1, 2022 $14.25
January 1, 2023 $15.00

The Hourly Rate is $__________.

Overtime rate of pay is 1.5x the hourly rate of pay, which is $__________ per hour, for every hour or fraction thereof worked between
40 and 45 hours.

Au Pair will / will not be entitled to a raise or additional compensation. Please describe:

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

Wage Deductions:
Deductions to be taken in accordance with Massachusetts Law.
» Food/Beverage: up to $42 per week (daily food & beverage maximums: $1.50 for breakfast, $2.25 for lunch, and $2.25 for
dinner); lodging: up to $35 per week maximum.
– These maximum amounts are set by Massachusetts Law. For more details on deductions, go to
https://www.mass.gov/doc/notice-of-rights-for-domestic-workers/download.
– Deductions for food/beverage and lodging shall not reduce the au pair’s weekly compensation below $195.75.

Federal Deductions:
» Federal Income Tax: According to the IRS, non-immigrants, such as au pairs on a J-visa, are not subject to withholding for
social security or federal unemployment tax. Please consult
https://www.irs.gov/individuals/international-taxpayers/au-pairs and your tax advisor for further details.
» Social Security/Medicare: According to the IRS, non-immigrants, such as au pairs on a J-visa, are not subject to withholding for
social security or unemployment. Please consult State Income Tax:
https://www.irs.gov/individuals/international-taxpayers/au-pairs and your tax advisor for further details.

State Deductions:
Massachusetts does not maintain specific guidance applicable to au pairs temporarily in the U.S. as nonresident aliens on a J-1
cultural exchange visa.
» MA State Income Tax: Host families should confirm with their tax advisor, but Au Pair in America’s understanding is that no
withholding of MA state income tax is required for au pairs.

Massachusetts Addendum APIA2020

 State Unemployment Tax (SUTA) and Worker’s Compensation Insurance:
» The MA Department of Unemployment Assistance has given no clear guidance on this point, however, it is likely that au pairs
are eligible for state unemployment. Families seeking further guidance are encouraged to speak to their tax advisor or contact
the Department of Unemployment Assistance at 617-626-6800 (mass.gov/dua).
» The MA Department of Industrial Accidents has given no clear guidance on this point, however, it is likely that au pairs are
eligible for state workers’ compensation benefits. Families can contact their homeowner’s insurance carrier or a payroll service
such as GTM Payroll Services (https://gtm.com/household/).

Au Pairs will receive the following Benefits:

In accordance with DOS or MDWBORA
» Transportation or reimbursement for transportation to and from educational classes.
» Medical Insurance as specified in DOS Regulations.
» Automobile Insurance coverage if the au pair is required to drive as part of childcare assistance responsibilities.
» Cell phone coverage cost if required as part of childcare assistance responsibilities.
» Free and Reasonable access to Internet services must be given to au pairs if host family has internet service.

If host families provide other goods or services to au pairs (e.g. gym/pool/club memberships, personal air/bus/train travel, gifts, etc.)
that are not required under the terms of the Au Pair in America program, DOS regulations, or Massachusetts law, families may use
their discretion to forego such goods or services, which may have been provided to previous au pairs who assisted your family.
» Sick Leave: Au Pairs must receive at least the DOS required weekly minimum stipend regardless of actual hours worked in a
week. Au Pairs, per the MDWBORA, have the right to earn and use up to 40 hours of sick time in a calendar year.
» Living Accommodation: DOS regulations state that an au pair may not be placed with a family that cannot provide the au
pair with a suitable private bedroom. Please consult the MDWBORA for further Privacy requirements.

Raising and Addressing Grievances:

Host families and au pairs are encouraged to work together to resolve any grievances or issues that may arise during the course of
the placement. To the extent that a grievance cannot be resolved, Au Pair in America provides the following resources to assist with
resolution of grievances:
» Level One: Local Community Counselor
» Level Two: Regional Program Manager, APIA Main Office, 1-800-9AUPAIR
» Level Three: Assistant Director, APIA Main Office, 1-800-9AUPAIR

The DOS has activated a helpline to ensure the health and safety of its exchange participants, including au pairs. All participants have
a right to be treated fairly and to report abuse without retaliation or threat of program cancellation. Au pairs can contact the DOS at
any time via the hotline 1-866-283-9090 or at jvisas@state.gov.

The Massachusetts Attorney General: 617-727-3465

Kids in Care Book:

The Kids in Care Book may be used to outline the weekly schedule, hours, and childcare assistance responsibilities. If you do use
this book, you must include the weekly schedule (including meal/rest breaks and off duty times), hours, and childcare assistance
responsibilities in this agreement. Host families and au pairs must maintain weekly time sheets and sign them each week to
acknowledge actual hours worked.

As required under DOS Regulations:

» Au pairs may provide up to 45 hours of childcare assistance per week (30 hours for EduCare); no more than 10 hours per day.
» Au pairs are to receive at least 1.5 days off per week and one full weekend per month.
» Au pairs are to receive a furnished private room and full board consisting of 21 meals per week/3 full meals per day.
» A minimum stipend of $195.75 per week regardless of how many hours of childcare the au pair provides (up to the regulatory
maximum of 10 hours per day and 45 hours per week).

Massachusetts Addendum APIA2020

 Rest Period:
According to the MDWBORA rest periods must be free of all work duties and au pair must be allowed to leave the host family
residence during rest periods. Such rest periods must be identified and included in this agreement.

According to MDWBORA an au pair is due a rest period during working hours if they work six or more hours in a day. Au pairs may
choose to work if they want but must be paid. Host families and au pairs should agree on this when establishing this agreement in
writing here:

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Vacation:
Under DOS regulations, au pairs are entitled to a minimum of two weeks of paid vacation with pay of at least $195.75 per week,
or at least $250 per week for Extraordinaire. Families and au pairs should discuss a mutually acceptable time for the au pair to take
vacation during the Placement.

In addition, the au pair will receive the following Federal/State/Religious holidays off throughout the year listed here:

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Termination or Severance of Employment:

The MDWBORA requires written notice and either 30 days of lodging, either on-site or off-site, or severance pay equivalent to
Domestic Worker’s average earnings during the last two weeks of employment, pursuant to M.G.L. c. 149, § 190(k). The host family
and au pair agree that the placement end date included above is the expected end date of the placement. This information is
intended to constitute advance notice of the conclusion of the placement.

No advance notice or severance payment shall be required where the employer provides a good faith allegation that the domestic
worker has abused, neglected, or caused any other harmful conduct against the employer, members of the employer’s family, or
individuals residing in the employer’s household, as described in 940 C.M.R. 32.03(19).

Separately, if Au Pair in America determines that the placement cannot be continued, it will provide assistance that may include, in its
discretion, placement of another au pair/companion with the host family. Where rematch is deemed appropriate, reasonable effort
will be made to find alternate placements for all parties. The Host Family is responsible for hosting the au pair for up to two weeks
until alternate arrangements can be made. The au pair is expected to continue to perform child care services during this period.
The au pair is not to be asked to depart from the residence by the host family without a Community Counselor’s knowledge and
involvement.

We have reviewed this addendum agreement together

Host Family Signature: ______________________________________

Au Pair Signature: ______________________________________

Date: ______________________________________

Massachusetts Addendum APIA2020