Australian School Homestay Experience

Host Family Application Form

If you would like to apply to be registered as a Host Family with us, please fill out and submit the following application form. The form is quite comprehensive because we are careful about the suitability of every prospective guest for your family. If you have questions or concerns relating to any part of this form, please feel free to contact us.

Section 1 - You

First Name

Last Name

Age

Gender

Male Female

Occupation

Do you smoke?

Yes, regularly Only socially No, never

Do you drink alcoholic beverages?

Yes, regularly Only socially No, never

What is your dietary conviction?

Meat-eater (I have no meat restriction at all)
Semi-vegetarian (I eat very little meat or only white meat)
Vegetarian (I eat only plant foods and dairy products)
Vegan (I eat no animal products at all)

What is your first language?

What other languages do you speak?

Please specify:

What language do you speak at home?

Ethnic Origin


Other, please specify:

Marital Status

Married De facto Single
Other, please specify

Section 2 - Your Partner

First Name

Last Name

Age

Gender

Male Female

Occupation

Do you smoke?

Yes, regularly Only socially No, never

Do you drink alcoholic beverages?

Yes, regularly Only socially No, never

What is your dietary conviction?

Meat-eater (I have no meat restriction at all)
Semi-vegetarian (I eat very little meat or only white meat)
Vegetarian (I eat only plant foods and dairy products)
Vegan (I eat no animal products at all)

What is your first language?

What other languages do you speak?

Please specify:

What language do you speak at home?

Ethnic Origin


Other, please specify:

Section 3 - Children and Adults in your Household

Do you have any children or other adults living with you?

Children: Yes No
Other Adults: Yes No

How many children do you have?

Still at home: Left home:

Your childrens ages and genders (who live at home with you):

Child 1 Age: Male Female
Child 2 Age: Male Female
Child 3 Age: Male Female
Child 4 Age: Male Female
Child 5 Age: Male Female

Other adults ages and genders (who live at home with you):

Adult 1 Age: Male Female
Adult 2 Age: Male Female
Adult 3 Age: Male Female
Adult 4 Age: Male Female
Adult 5 Age: Male Female

Section 4 - Address

Unit Number

Street Number

Street Name

Street Type


(type first letter of street type to jump through list)

Suburb

Town or City

State or Province

Country

Post Code

Section 5 - Phone, Fax & Email

Home Phone

Home Fax

Email - you

Email - your partner

Mobile - you

Mobile - your partner

Work - you

Work - your partner

Section 6 - Experience

Have you or your partner ever hosted students before?

Yes, please complete this Section
No, please go to Section 7

Please name atleast one institution we can contact for a reference

Institution Name:
Contact Person:
Phone:

Which countries have your guests come from?

Are you currently hosting guests?

Yes, please answer the next questions
No, please go to Section 7

Do you currently have a vacancy for a new guest?

Yes No

How many guests do you have staying with you now?

Current number of guests:

How much longer will your guests be staying with you? (if known)

Guest 1: Don't know
Guest 2: Don't know
Guest 3: Don't know

Section 7 - Legal and financial requirements

Do you hold a Blue Card?

Yes No
If yes, Name on card:
Registration Number:
Expiry Date:

Does your partner hold a Blue Card?

Yes No
If yes, Name on card:
Registration Number:
Expiry Date:

If any adult resident in your household does not have a Blue Card, please visit the Commission for Children and Young People and Child Guardian to download a "Volunteer" application form for each adult resident. Valid Blue Cards must be held by all adult members of your household before guests can be placed in your homestay. This is a mandatory requirement for all new Host Family Applications. Please contact us on 3385 5300 for assistance with your forms.

Do you or your partner hold Public Liability Insurance for Homestay Students?

Yes No Not Sure

We urge all host families to check with their insurance provider about their public liability insurance cover, in particular for paying boarders. Please contact your insurance provider for verification or contact us on 3385 5300 for assistance.

Please indicate your weekly rental for full board, English conversation and care

A. Room only, guest prepares own meals:
Weekly rent: $

B. Room plus 2 meals per day:
Weekly rent: $

C. Room plus 3 meals per day:
Weekly rent: $

Section 8 - Your Guest Preferences

Male

Yes No Maybe

Female

Yes No Maybe

 

 

Single

Yes No Maybe

Couples

Yes No Maybe

 

 

Two sisters

Yes No Maybe

Two brothers

Yes No Maybe

Two friends

Yes No Maybe

Parent(s) with children

Yes No Maybe

 

 

Overseas Student

Yes No Maybe

Working Holiday Guest

Yes No Maybe

Holiday Guest

Yes No Maybe

Australian Student

Yes No Maybe

Travellers

Yes No Maybe

 

 

Short Term Stay

Yes No Maybe

Long Term Stay

Yes No Maybe

 

 

6-11 yo with parent/guardian

Yes No Maybe

12-15 yo with parent/guardian

Yes No Maybe

16-17 yo teenager

Yes No Maybe

18-25 yo adult

Yes No Maybe

26-29 yo adult

Yes No Maybe

30-39 yo adult

Yes No Maybe

40-49 yo adult

Yes No Maybe

50-59 yo adult

Yes No Maybe

60-69 yo adult

Yes No Maybe

70-79 yo adult

Yes No Maybe

 

 

Do you prefer smokers?

Yes No

Do you accept smokers if they smoke outside?

Yes No

Do you allow smoking inside the home?

Yes No

 

 

Preferred Nationalities?

By Continent:

(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

By Country:

(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

Other preferences
(please state):

Section 9 - Pets

Do you have any pets?

Yes No

If yes, please specify type of pets:

Dog, How many? Breed(s):
Cat, How many? Breed(s):

Please select any other pets you have from the list:

 (Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

Or specify other pet types here:

Section 10 - Guest Rooms and Beds

Your number of guest rooms for guests/students?


Other number of guest rooms, please specify:

Please select the type of room(s) you have available for guests:


(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

Other types of guest rooms, please specify:

Please tick which rooms guests may share:


(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

Other rooms guests may share, please specify:

Total number of spare beds available?   

Single: other, please specify:
Double:other, please specify:
Queen:other, please specify:
King:other, please specify:

Section 11 - Guest Room Furnishings

Room 1:


(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)


Other furnishings for Room 1, please specify:

Room 2:


(Hold down the CTRL key (Windows) or CMND key (Mac) to select more than 1)

Other furnishings for Room 2, please specify:

Section 12 - Other items available for Guests to use

Computer

Audio/Video

Laundry

Kitchen



Kitchen appliances, please specify:

Outside - Back Yard

Modes of Transport



Other modes of transport, please specify:

Section 13 - Public Transport Facilities

Railway Station:

Nearest Railway Station Name:

Car:
Bus:
Bicycle:
Walk:

Bus Stop:

Nearest Bus Stop Number:

Car:
Walk:

Translink zones from Brisbane CBD (SE Qld only)

Section 14 - Your Hospitality

Are you able to drop off and pick up the students or guests from school, college or Uni?

To / from School, College or Uni: Yes No
To / from Bus Stop: Yes No
To / from Train Station: Yes No

Are you willing and able to read a story book or two to the students or guests each evening?

Yes No

Are you willing and able to converse with the students or guests in the evenings?

Yes No

Are you able to do the students or guests laundry?

Yes No

Would you have a NO-SMOKING policy in your home while guests are present?

Yes No

Can you accommodate any special dietary requirements if necessary?

Vegetarian? Yes No Not sure
Vegan? Yes No Not sure
Lactose free? Yes No Not sure
Gluten free? Yes No Not sure
Wheat free? Yes No Not sure
Halal? Yes No Not sure
Can accommodate any diet request Yes No Not sure

Section 15 - Your family's Interests & Hobbies

Outdoor Leisure

Sports

Musical



Musical instrument(s), please specify:

Arts & Crafts

Social

Technical

Other hobbies & interests, please specify:

Section 16 - Photographs

Do you have digital photographs or prints available to send to us (with your consent)?

Photo of spare room
Photo of front of house
Photo of living area
Family portrait or snap
Other, please specify:


Sending digital photos via a separate email
send to: info@homestayexperience.com
Sending prints via the Post
post to:
Homestay Experience,
PO Box 377,
Narangba, Qld, 4504
Australia

Section 17 - Questions & Comments

Please type your questions or further comments here:

Section 18 - Privacy & Confidentiality Statement

Please click on the following link to read our Privacy Statement

I / We have read the Homestay Experience Privacy Statement and agree with it.

Section 19 - Declaration

Please complete the following declaration and submit the form by clicking the submit button below

I / We hereby authorise Homestay Experience to collect personal information about me / us, which directly relates to this application.
I / We hereby give consent to Homestay Experience to collect digital or print photograph's of my/our home, as indicated in Section 16 of this Form, for the purposes of showing them to prospective students/guests who are considering my/our home as a place to Homestay, from time to time.
I / We hereby give consent to Homestay Experience to collect digital or print photograph's of myself/my family members, as indicated in Section 16 of this Form, for the purposes of showing them to prospective students/guests who are considering my/our home as a place to Homestay, from time to time.
I / We certify the information supplied on this application form is complete, true and correct.

Your Full Name:

Your Partner's Full Name:

If all this sounds like you then you may be that special family or person we are looking for!

We will be in touch with you shortly. Thank you for your interest in Homestay Experience.

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