Student Name:

E-mail Address:

200 Bolinas Road Suite 36,
Fairfax, California 94930
415-509-6757
basil@adventurehomestays.org

HOST FAMILY APPLICATION

**Please use this form to fill in on-line by typing in the fields.

If you have questions, please call us before completing your application - 415-509-6757

Your application should be completed digitally and printed to be sure it can be clearly and accurately read. Your completed application will be automatically be e-mailed to AHA.

FAMILY INFORMATION

Parent

Name:

Occupation:

Employer:

Working hours:

Working days:

Work Phone:

E-mail Address:

2nd Parent:

Name:

Occupation:

Employer:

Working hours:

Working days:

Work Phone:

E-mail Address:

Family Address:

City:

State:

Zip Code:

Home Telephone:

E-mail Address:


(For communication with student you are hosting)

OTHER MEMBERS OF THE HOUSEHOLD

Name:

Age:

Son / Daughter / Other:

Interests / Hobbies / Occupation:

Name:

Age:

Son / Daughter / Other:

Interests / Hobbies / Occupation:

Name:

Age:

Son / Daughter / Other:

Interests / Hobbies / Occupation:

Name:

Age:

Son / Daughter / Other:

Interests / Hobbies / Occupation:

 

What other activities/hobbies does your family enjoy?

 

Does anyone in the household speak another language? If so, who, and which languages?

 

Does your family have any pets?

If so, what kind, how many, indoors/outdoors?

 

Has your family ever hosted an international student?

 

What are your family expectations in hosting an international student?

 

Explain the rooming situation:

Does anyone in the household smoke?

Would you agree to hosting a student who smokes?

Does any member of the household suffer from any chronic illness? If so, please specify who, and nature of illness:

REFERENCES

Name:

Address:

Phone:

Name:

Address:

Phone:

PLEASE SIGN BELOW

You may sign this application by typing your name(s) and using your mouse, touchpad or finger to draw your signature(s) in the boxes below:

Signature of parent #1:

Signature of parent #2:

 

PLEASE ADD A FEW PHOTOS BELOW

We request that you attach a few photos using the "Add Photo" box below.

0%