Host Family Application Form

Head of Household
(Person to be contacted primarily)
Birth date

MonthDayYear
Gender
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address
County of Residence
Must be a resident of Orange County, Calif.
Mobile Phone
Home phone
If no home phone, leave bl;ank
Work phone
If no home phone, leave bl;ank
Text communication
Type a question

Other
Why do you want to become an OC Riptide host family?
What date is the earliest you can host an OC Riptide player? (Players start arriving late May / early June.)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

References

Rows	Name	Relationship to your family	Email	Phone
1
2

Housing Accommodations (Check all that apply)
Any additional amenities available to players staying with you?
Community clubhouse privileges, proximity to beach, shopping, entertainment, etc.

Family members and/or roommates: (If single, place N/A in box 1)

Pets in the home? (If none, place N/A in box 1)

Please answer the following questions as they apply to you and/or any additional residents that will be living in the home this summer while a player is staying with you.

Please answer to the best of your knowledge.

(Answering "yes" to any of the following questions is not grounds for immediate disqualification.)

Rows	YES	NO
Has been arrested or convicted of a misdemeanor or felony other than parking violations?
Uses illegal substances or is chemically dependent?
Has a complaint filed with an agency dealing with child abuse or neglect?
Death or suicide of immediate family member?
History of mental Illness or psychiatric counseling?

DID WE MISS ANYTHING? Now is the time to tell us why you would make a fantastic host family for an Orange County Riptide player this summer!
Be as detailed or brief as you like.
Certification:
Signature

Please sign your name
Should be Empty:

Orange County Riptide Host Family Application