Medowie Christian School

CONTACT DETAILS FOR MAIN CONTACT IN HOUSEHOLD

Title *

First Name *

Last Name *

Street Address *

Suburb *

State *

Postcode *

Phone

Mobile *

Email *

OTHER INFORMATION

HAVE YOU HOSTED A FOREIGN STUDENT BEFORE? *

Yes

No

WHAT IS THE MAIN LANGUAGE SPOKEN IN YOUR HOME? *

English

Other (please describe below)

Other Languages

PLEASE INDICATE YOUR HOMESTAY STUDENT PREFERENCE *

Male

Female

Either

NUMBER AND TYPE OF PETS

PLEASE INDICATE IF YOU HAVE PETS *

Yes

No

Please indicate how many of each pet is in your household (or use the 'Other Pets' field for animals not listed)

Dog *

Cat *

Bird *

Rabbit *

Guinea Pig *

Horse *

Cow *

Other (describe below)

Other Pets

HOUSEHOLD MEMBERS

How Many People in Your Household (including yourself)? *

HOUSEHOLD MEMBER #1

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #2

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #3

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #4

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #5

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #6

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #7

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #8

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #9

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

HOUSEHOLD MEMBER #10

Full Name *

Date of Birth *

Name of School or Occupation *

Gender *

Male

Female

Working With Children Number

ADDITIONAL INFORMATION

Who We Are

Homestay

Value Learning