Host Family Registration Form

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Atherton Tableland
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HOST FAMILY REGISTRATION FORM

* Indicates required field

Contact Person *

First

Last

[object Object]

Phone Number *

Email *

Address *

Suburb *

Postcode *

State *

Postal Address *

Type of Home *

Transportation ( ) min to closest Town *

Husband's Occupation *

Examples; NT = No, there isn't / Retired / Teacher / FT (Full Time) Housewife etc...

Transportation ( ) min to School *

Wife's Occupation *

Examples; NT = No, there isn't / Retired / Teacher / FT (Full Time) Housewife etc...

Language spoken at home *

English and Others

Experiences as host family since *

YYYY

Wifi / Internet access *

Hobbies *

Introduction of your house, business, and family *

Pets / Animals *

House rules *

Family Member No1 = Contact Person *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.2 *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.3 *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.4 *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.5 *

Gender *

Date of Birth *

Family Member No.6 *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.7 *

Gender *

Date of Birth *

DD/MM/YYYY

Family Member No.8 *

Gender *

Date of Birth *

DD/MM/YYYY

Blue Card *

Eveyone over the age of 18 has Blue Card Some of the family members need to apply

Be prepared to act as carer for students under 18 years of age? *

Yes No

How many students are you able to take at once? *

Are you willing to host for ; *

Male Female Either

Are you prepared to provide ; *

Meat dish even if you are vegitarian Vegetarian Dish Gluten Free Other Special Dietary requirements

Are you able to offer accommodation during the Christmas period? *

Yes No Maybe

Maximum weeks of homestay provision ? *

Do you have current Public Liability Insurance as part of your householder's policy ? *

Yes No

Do you or your family member smoke? *

Yes No

May visitor/s smoke? *

No Yes outside

Submit

Crane Dance
Atherton Tablelands
Cairns
Brisbane
Gold Goast

Home
Atherton Tableland
About Us
Contact
J Camp