Application to be a Homestay

Application to be a Homestay

Please complete all sections of this form
As you may be aware, the New Zealand Government mandated vaccination for all staff and contractors providing services to schools. This includes families providing homestays to international students. The school has now adopted a policy to require that all those hosting international students, and members of their households (18 years of age and over) who are eligible to be vaccinated against Covid-19, are vaccinated.

So that you can be considered as a host family for our school, we require each eligible member of your household to complete a Covid-19 Declaration Form. If you have family or household members who are not willing to disclose this information, the household will be treated as unvaccinated and students will not be placed with you.

We understand that this may be a sensitive issue for some people and ask that if you have any questions or concerns about the policy, please get in touch.
Family Details
Primary Caregiver's Name*

First NameLast Name
Address*

Street Address

Suburb & Postcode

City

Postcode
Date of Birth*

DayMonthYear
Home Phone Number

Area CodePhone Number
Mobile Number*
Work Number

Area CodePhone Number
Email Address*
Occupation
Employer
Bank Account (for homestay payments)*
Secondary Caregiver's Name

First NameLast Name
Date of Birth

DayMonthYear
Mobile Number
Work Number

Area CodePhone Number
Email Address
Occupation
Employer
Total Number of Household Members*

Complete the details for each person living in the home (i.e. children, extended family members, boarders, etc.)

Rows	Name	DOB	M/F	Relationship to Hosts
1.
2.
3.
4.
5.
6.

Family interests and hobbies
Please provide details of any pets that you have
Accommodation Details

Each room must have a single or double bed, wardrobe, drawers and adequate lighting. The desk, chair and lamp can be located in a separate area.
OwnRentOther
Single StoreyHouseTwo StoreyApartment
Number of Rooms*

Number of BedroomsNumber of Bathrooms
How many rooms do you have available for International Students?*
Own bathroom and toiletShared bathroom and toiletShared bathroomDesk for study and study lampNo desk for studyInternet access and/or WiFiNo internet access and/or WiFi
Do you have installed regularly serviced working smoke alarms?*
Do you have a First Aid Kit?*
Student Preference
MaleFemaleEither
Long-termShort-term (i.e. 1 - 2 terms)Either
Do you wish to host any particular nationality?
Would you accept a student with special dietary requirements?*
General Information
TRANSPORT TO SCHOOL

Please advise the easiest way for the student to travel to and from school.

Please note: We are generally only able to accept homestay families who are in walking distance or within one bus stage of our school. This is because students like to be able to easily get to and from school and to meet their friends at weekends and after school.
- Walking - minutes
- By Car - minutes
- By Bus - minutes
- If Bus, please advise cost per trip $ bus fare
What is the main language spoken at home?*
What is the second language spoken at home?
Religion
Do you regularly attend church?
Do you observe any specific dietary customs? If yes, please detail below.
Does either host parent go away overnight or weekends? If yes, please provide details.
Does any family member have a medical condition the student should know about? If yes, please provide details.
Do both caregivers have a full driver's licence?*
Do any members in your household smoke?*
Do you have any relatives/friends who sometimes stay with you who you have not mentioned? If yes, please provide details.
Reasons for offering homestay accommodation
Emergency Contact

A contact outside your immediate family
Emergency Contact Name*

First NameLast Name
Mobile Number*
Email*
Relationship to Caregivers
Referees

Please include people who have known you and your family for more than 12 months, be at least 16 years of age, are not extended family members or live at the same address, i.e. work colleagues or family friends.
Referee 1*

First NameLast Name
Referee 1 Email*
Referee 1 Mobile*
Referee 2*

First NameLast Name
Referee 2 Email*
Referee 2 Mobile*
Any other comments or requests.
Police Vetting
Every person living in your home (or someone who regularly stays overnight in your home) who is 18 years of age or over must submit a police vetting form. You will also need to send us copies of two forms of ID, i.e. passport and drivers licence for each household member completing the form. We will need to sight the originals when we meet with you in person.
Police Vetting Form (please complete Sections 2 and 3)
Police Vetting Guide

Send completed police vetting forms and copies of ID as an attachment to: international@ormiston.school.nz (please ensure the subject line reads Homestay Application - and use your surname as a reference)
Vaccination Declaration
Please complete a Covid-19 Declaration Form for every household member eligible for the vaccine.

Covid-19 Declaration Form

Send completed vaccination declaration forms as an attachment to: international@ormiston.school.nz (please ensure the subject line reads Homestay Application - and use your surname as a reference)
Photos
We require 3 photos (.jpeg or .png file) which will be held on file and sent, as part of your family profile, to a new student. We require:
1. The outside of your home
2. The student's bedroom
3. Your family members

Send digital copies as an attachment to: international@ormiston.school.nz (please ensure the subject line reads Homestay Application - and use your surname as a reference)
Please note the following before submitting your form
- Being a homestay family should not be relied upon as a constant source of income. Students come for short or long stays and when one leaves we may not be able to place a student with you again immediately.
- Homestay payments should be considered more of a reimbursement for costs associated with having an additional person in your family rather than an additional source of income.
TERMS & CONDITIONS

Thank you for offering to become a homestay for International Students attending Ormiston Senior College. If you accept a student for homestay, then the Terms and Conditions upon which the homestay is to be provided by you shall be set out in the Homestay Carer Agreement and will continue to apply for homestays arranged through Ormiston Senior College. Any amendments or variations to the Residential Caregiver Agreement shall only have effect as notified to you in writing by Ormiston Senior College. In addition, for any changes relating to a move of a student from your home due to any un-notifiable change whereby the student must move, the notice period may not apply.

ACCEPTANCE OF TERMS

I acknowledge that the above information is true and correct and that I have read and understood the Homestay Carer Agreement. I consent to Ormiston Senior College International Department sharing my contact details with other host families.
I/We hereby acknowledge and agree to the Homestay Carer Agreement
Should be Empty:

Application to be a Homestay

Family Details

Accommodation Details

Student Preference

General Information

Emergency Contact

Referees

Police Vetting

Vaccination Declaration

Photos

Please note the following before submitting your form