Host Family Application

HOST FAMILY APPLICATION

PLEASE NOTE: This form does not confirm you will be selected as a host family. We will be in touch with you via phone or email.
PRIMARY HOST STUDENT

Please tell us about the primary host student.
What school do you attend?*
Student Name*

First NameMiddle NameLast Name
Preferred Name
Upload a picture of yourself*

Cancelof
Upload a picture of your family*

Cancelof
Student E-mail*
example@example.com
Gender*

MaleFemaleX
Birth Date (MM/DD/YYYY)*
How old will you be at the time of hosting?*
Student Cell

Area CodePhone Number
Student Cell
Please enter a valid phone number.
Would you like us to share your phone number with your exchange partner once you are matched?*

YESNO
Would you like to share your Social Media contact info with your matched student?*

NOYES
If yes, please list any social media accounts that you would like to share
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do you get to school?*

I take the busI drive myself to schoolMy parent/guardian drives me to schoolI walkOther
What bus number do you ride?
If other, please explain
Additional Comments
Describe your personality (select all that apply)*

ShyOutgoingOrganizedDisorganizedTalkativeQuiet/CalmActiveLike to study/readWorry a lotLaid back (not easily worried)IndependentFriendly
Hobbies / Interests (select all that apply)*

AerobicsAnimeArtBadmintonBalletBandBaseballBasketballBicyclingBowlingBoy Scouts/Girl ScoutsCampingChoir/SingingComputersCookingDancingDrama/TheaterDrawing or PaintingFishingFootball (American)Games & CardsGolfGymnasticsHikingHockeyHorseback RidingIce SkatingListening to MusicMarching BandMartial ArtsMoviesMusical InstrumentPhotographyReading/WritingRoller SkatingSailingSewingShoppingSkateboardingSkiing/SnowboardingSoccerSoftballSwimmingTennisTrack & Field/RunningVideo GamesVisiting Historic SitesVisiting MuseumsVolleyballWater-skiing
If you play a musical instrument, what instrument(s) do you play?
What clubs or activities do you do after school or in your free time?*
What do you like to do on weekends with your family or friends?*
What languages are you studying?*

GermanFrenchItalianLatinSpanishOtherNone
If other, please explain
Tell us how many years you have studied each language
What is your favorite subject in school and why?*
Is there anything else we should know to help us match you with an international visiting student?*
PARENT / GUARDIAN INFORMATION
Parent/Guardian (1) Name*

First NameLast Name
Primary Parent/Guardian (1) Phone

Area CodePhone Number
Primary Parent/Guardian (1) Phone*
Please enter a valid phone number.
Primary Parent/Guardian (1) Email*
example@example.com
What is the best way to reach Parent/Guardian (1)?*

PhoneEmail
Parent/Guardian (1) Job Title or Role*
Is there a second parent in the home?*

YESNO
Parent/Guardian (2) Name

First NameLast Name
Primary Parent/Guardian (2) Phone

Area CodePhone Number
Primary Parent/Guardian (2) Phone
Please enter a valid phone number.
Primary Parent/Guardian (2) Email
example@example.com
What is the best way to reach Parent/Guardian (2)?

PhoneEmail
Parent/Guardian (2) Job Title or Role
ABOUT THE HOME
Have you ever hosted an exchange student before?*

YESNO
How many students can you host?*
If needed, could you host an additional student?*

YESNOPOSSIBLY
Can you host a teacher/chaperone if all students are placed?

YESNOPOSSIBLY
Would you prefer to host a girl or boy?*

GirlBoyIt doesn't matter!
Please list all host siblings names and ages. If you do not have host siblings, please put N/A*
Besides any siblings listed above, who else lives at home with you? Include names, ages, and relationship to host student*
What are your current living and hosting situations (select all that apply)*

HouseApartmentCondoStudents will share a roomWill host any genderWill host chaperoneSmoking allowedWe follow a special diet
Do you have any pets?*

YESNO
What types of pets do you have?

CatsDogsFishHorsesRabbitsSnakesOtherNo pets
If you selected other, please explain
Are your pets indoor or outdoor pets?

Indoor petsOutdoor petsI have no pets
Please describe the temperament of your pets, and anything else we should know about them
Does anyone in your home follow a modified diet (lactose/gluten-free, vegetarian/vegan, or other)?*

YESNO
If yes, please explain:
Would you be willing to host a student with food allergies, or a special diet such as vegetarian, vegan, lactose-free, gluten-free, or other modified diet?*

YESNO
Would you be willing to host a student with severe allergies such as Celiac, or a severe Nut Allergy?*

YESNO
Please provide any additional details about your home that we should know
TERMS
I will host a student(s) in my home while they are visiting during a homestay exchange program organized by Hummingbird Student Tours.*

I agree
I agree to provide a safe and sanitary place for my visiting student(s).*

I agree
I agree to assist with transportation for any medical issues, if necessary.*

I agree
I agree to treat my visiting student(s) with respect and kindness during their stay.*

I agree
If there are guns in the home, I will ensure they are in a securely locked location while the visiting student(s) is in my home.*

I agree
I acknowledge that the visiting student(s) may be under the age of 18 and that the visiting student(s), their parents, and their teachers will be held responsible for the student's actions while they are visiting.*

I agree
I release Hummingbird Student Tours and its officers, directors, shareholders, employees, volunteers, partners, agents and representatives from any liability, including but not limited to liability for damage, illness, injury or death, expense, inconvenience, delay or other loss in connection with the tour. Hummingbird Student Tours does not own or operate any of the suppliers of services or accommodations for this trip, and, as a result, is not responsible for any negligent or willful act or failure to act of any supplier or of any third party over which Hummingbird Student Tours has no control.*

I agree
To the best of my knowledge, I have answered all the questions honestly and have not withheld any information that could put my visiting student(s) in a precarious or dangerous situation.*

I agree
I agree to immediately contact Hummingbird Student Tours with any questions or concerns as they arise.*

I agree
Photo Release
I hereby grant permission for my student to be photographed and/or recorded in connection with the homestay exchange program organized by Hummingbird Student Tours. I further authorize the photograph(s) and/or recording(s) to be utilized in promotional materials and/or social media content. I waive any right to inspect or approve the use of any photograph(s) and/or recording(s) and acknowledge and agree that the rights granted to this release are without compensation of any kind.
I agree to the photo release*

YESNO
Future Travel
Is the host student interested in traveling if the school travels?*

YesNoNot sure yet
If yes, would you prefer a homestay or a tour?

HomestayTourEither is fine!
Signature of Parent/Guardian
I understand everything*

YES
Signature of Parent/Guardian*

Clear
Are you really human?
Hummingbird Student Tours

PO Box 3063 Bourne, MA 02532 USA | tel & sms: +1-617-333-8569, +1+617-334-5844 info@hbstudenttours.com www.hbstudenttours.com
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HOST FAMILY APPLICATION

PRIMARY HOST STUDENT

PARENT / GUARDIAN INFORMATION

ABOUT THE HOME

TERMS

Photo Release

Future Travel

Signature of Parent/Guardian

Hummingbird Student Tours