HOST FAMILY REGISTRATION

EXCHANGE STUDENT
HOST FAMILY
REGISTRATION FORM

Parent 1 Name

Parent 2 Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Format: 000-000-0000.

Parent 1 Cell Phone

Format: 000-000-0000.

Parent 2 Cell Phone

Format: 000-000-0000.

Children's Name and Ages

How many people are in your household?

What other Languages do you speak?

How well do you speak them?

Please indicate if you have pets.

Do you have diet restrictions? (Are family members vegetarians?)

What do you like to do? (art, music, sports, other activities)

What do you wish to learn from this homestay?

How many students would you like to host?

Each student must have their own bed.

Parent 1 Signature

Date

Parent 2 Signature

Date

Questions contact: Theresa Pan Hosley tpan@seasonstotheworld.com