Clone of Host Families 25 - Registration Form

Host Families - Registration Form
Contact Details:
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Another contact number*

Area CodePhone Number
E-mail*
example@example.com
Select your program?*
Would you like to host children, coaches or either?*
How many children could you host?*
What age would you prefer?*
Would you prefer to host a boy or a girl?*
How many coaches could you host?*
Let us know your preferences if needed
Are all the members of your family Irish/ Northern Irish, and is English the language spoken in the house?*
Hosting address*

Street Address

Street Address Line 2

CityState / Province

Eircode / Postcode
FAMILY MEMBERS LIVING IN THE HOUSE
How many adults (16 and up at the time of the program) will be interacting/living in the house with our student*
How many children (under 16 at the time of the program) will be interacting/living in the house with our student*
ADULT 1 - FULL NAME*
ADULT 1 - AGE*
ADULT 1 - GENDER*
ADULT 1 - PROFESSION*
ADULT 1 - NATIONALITY
Nationality if it's other than Irish
ADULT 1 - LANGUAGE
Language if it's other than english.
ADULT 2 - FULL NAME*
ADULT 2 - AGE*
ADULT 2 - GENDER*
ADULT 2 - PROFESSION*
ADULT 2 - NATIONALITY
Nationality if it's other than Irish
ADULT 2 - LANGUAGE
Language if it's other than english.
ADULT 3 - FULL NAME*
ADULT 3 - AGE*
ADULT 3 - GENDER*
ADULT 3 - PROFESSION*
ADULT 3 - NATIONALITY
Nationality if it's other than Irish
ADULT 3 - LANGUAGE
Language if it's other than english.
ADULT 4 - FULL NAME*
ADULT 4 - AGE*
ADULT 4 - GENDER*
ADULT 4 - PROFESSION*
ADULT 4 - NATIONALITY
Nationality if it's other than Irish
ADULT 4 - LANGUAGE
Language if it's other than english.
ADULT 5 - FULL NAME*
ADULT 5 - AGE*
ADULT 5 - GENDER*
ADULT 5 - PROFESSION*
ADULT 5 - NATIONALITY
Nationality if it's other than Irish
ADULT 5 - LANGUAGE
Language if it's other than english.
CHILD 1 - FULL NAME*
CHILD 1 - GENDER*
CHILD 1 - AGE AT THE TIME OF THE PROGRAM*
CHILD 1 - DATE OF BIRTH*

MesDíaAño
Fecha
CHILD 1 - IS THIS CHILD ATTENDING THE PROGRAM?*
CHILD 1 - NATIONALITY
Nationality if it's other than Irish
CHILD 1 - LANGUAGE
Language if it's other than english.
CHILD 2 - FULL NAME*
CHILD 2 - GENDER*
CHILD 2 - AGE AT THE TIME OF THE PROGRAM*
CHILD 2 - DATE OF BIRTH*

MesDíaAño
Fecha
CHILD 2 - IS THIS CHILD ATTENDING THE PROGRAM?*
CHILD 2 - NATIONALITY
Nationality if it's other than Irish
CHILD 2 - LANGUAGE
Language if it's other than english.
CHILD 3 - FULL NAME*
CHILD 3 - GENDER*
CHILD 3 - AGE AT THE TIME OF THE PROGRAM*
CHILD 3 - DATE OF BIRTH*

MesDíaAño
Fecha
CHILD 3 - IS THIS CHILD ATTENDING THE PROGRAM?*
CHILD 3 - NATIONALITY
Nationality if it's other than Irish
CHILD 3 - LANGUAGE
Language if it's other than english.
CHILD 4 - FULL NAME*
CHILD 4 - GENDER*
CHILD 4 - AGE AT THE TIME OF THE PROGRAM*
CHILD 4 - DATE OF BIRTH*

MesDíaAño
Fecha
CHILD 4 - IS THIS CHILD ATTENDING THE PROGRAM?*
CHILD 4 - NATIONALITY
Nationality if it's other than Irish
CHILD 4 - LANGUAGE
Language if it's other than english.
CHILD 5 - FULL NAME*
CHILD 5 - GENDER*
CHILD 5 - AGE AT THE TIME OF THE PROGRAM*
CHILD 5 - DATE OF BIRTH*

MesDíaAño
Fecha
CHILD 5 - IS THIS CHILD ATTENDING THE PROGRAM?*
CHILD 5 - NATIONALITY
Nationality if it's other than Irish
CHILD 5 - LANGUAGE
Language if it's other than english.
PETS AT HOME
Do you have any dogs living in the house?*
Are any of your dogs considered as a RESTRICTED BREED IN THE COUNTRY?*
Do you have cats living in the house?*
Do you have any other pets in the house?*
Tell us more information if needed:
How did you hear about us?*
Could you please send us a few quality pictures of the house, garden, kid's room, kitchen? 4-5 photos is enough. If you don't have the pictures or the documents at this moment you can send them in the coming days.

Cancelof
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Host Families - Registration Form

FAMILY MEMBERS LIVING IN THE HOUSE

PETS AT HOME