TIDE Host Application Form

Please provide the information below for each member of your Family and/or Household who will be 17 years of age or younger, as well as any children 17 & younger who will be staying in the household during the exchange student's stay, as well as any family children not in the home.
How many members of the Family and/or Household are 17 yrs and younger at the time of the student exchange?

01-67 or more
PLEASE COMPLETE ALL FIELDS - add rows as needed for each additional person:*
Is there anything TIDE or the exchange student/student's family should know about any of the anyone 17 & younger in the Family and/or Household?*

Do you have any pets/animals inside or outside of the house?*

YesNoOther
How many pets do you have?

123 or more
Configurable list
Please explain any further details about one or more pet(s). For example, are any of them prone to anxiety when introduced to strangers? Scratch? Bite? Expect attention? And so on... Anything else you think the exchange student should know.*

Type of community*

Urban/MetroSuburbanSmall Town/VillageRuralFarmOther
Estimated Population*
If you selected "other" for type of community, please explain
Nearest Major City*
Approximate Distance*
Nearest International Airport*
Approximate Distance*
What is the best International Airport for the exchange student to fly in and out of?*
City and/or airport code*
Briefly describe your neighbourhood and community (including points of interest)*
Are there any areas in our near your neighbourhood to be avoided?*

No, not reallyYes
If yes, please describe
Is there anything else about your community that the dance exchange student should know?*

Please list two (2) references that have known your family for at least 12 months. If yours is a single parent or adult home without children in the home, a third (3rd) reference is required. Under most jurisdictions, relatives or TIDE staff cannot be used as a reference.
PLEASE COMPLETE ALL FIELDS - add rows as needed for additional people:*
Will any of your listed references be your Emergency Contact? The Emergency Contact should be someone, either a neighbour, friend, or family member, who can be contacted by TIDE staff or the family of the exchange student in cases of emergency when you and/or the others in your household cannot be reached.*

Yes - it will be one of my listed referencesNo - it will be someone else
If your emergency contact is one of your listed references, which one?
Please write full name
Emergency Contact Name*

Given NameSurname
Relationship*
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Second Phone Number

Country CodeArea CodePhone Number

Medical Release:

The information I have provided is true and correct to the best of my knowledge. If in case of emergency, and no persons in the host family/household can be reached, a representative from TIDE or the family of the exchange student shall notify the emergency contact.

I hereby authorize the exchange student to perform life saving measures (CPR, First Aid) in the case of emergency and no other options or members of the family/household are able to do so. The primary host will have the necessary health information and insurance information of the exchange student and give assistance to receive appropriate caree if neccessary. All health information shall be kept private and sharable only to the proper authorities in an emergency or seeking care. If the exchange student does not have the proper medical insurance, they will be responsible for all costs of any medical expenses, not the host family.

Liability Release:

In consideration of being permitted to participate in any way in the activities at and to attend the TIDE program, I hereby release, waive, and discharge the TIDE program, its affiliates, agents, and employees from any and all claims resulting in personal injury, death, or property loss due to accident or illness arising from, but not limited to the activities and participation at and travel to and within the TIDE program. I understand that participation in activities at TIDE programs carry with it certain inherent risks that cannot be avoided regardless of the safety measures placed to avoid injuries. I agree to indemnify and hold harmless the TIDE program, its affiliates, its officers, and employees, from any and all claims, damages, and liabilities arising from damage and/or injuries from my participation in the TIDE program activities and my home(s) and vehicle(s) used in the exchange.

I hereby declare that I have carefully read the abovementioned waiver and release and acknowledge that I have read and understood the above information. I agree with its terms and conditions and after knowing the entirety of these facts and in consideration of the TIDE program acceptance of my family and/or household enrollment, I am signing this Health, Consent, and Liability Release form freely and voluntarily to release of all liabilities to the greatest extent allowed by law.
The following must be signed by the primary host contact and the secondary host if applicable.

A witness must sign if no secondary host was selected.
Name of Primary Host*

Given NameSurname
Date Signed*

MonthDayYear
Date
Signature of Primary Host*

Clear
Name of Secondary Host*

Given NameSurname
Date Signed*

MonthDayYear
Date
Signature of Secondary Host

Clear
Name of Witness

Given NameSurname
Date Signed

MonthDayYear
Date
Relation to Primary Host
Signature of Witness

Clear
Thank you so much for your time! You are greatly appreciated as part of the TIDE program family!

Please take the time to review your choices and then click 'SUBMIT'.

After you submit your application form, you will be redirected back to the TIDE program webpage.
Should be Empty:

The International Dance Exchange (TIDE) HOST FAMILY APPLICATION Form

#1 - PRIMARY APPLICANT - PARENT/OTHER OVER 18

#2 - PARENT/OTHER OVER 18

#3 - THIRD PERSON OVER 18