Host Families - Registration Form
Contact Details:
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Another contact number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Select your program?
*
Seleccione
Cork ( 5th to 18th July )
Dublin ( 19th July- 1st august)
Belfast ( 2nd to 15th August )
Would you like to host children, coaches or either?
*
Seleccione
Children
Coaches
Either
How many children could you host?
*
Seleccione
1
2
2+
What age would you prefer?
*
Seleccione
9
10
11
12
13
14
15
16
17
Would you prefer to host a boy or a girl?
*
Seleccione
Boy
Girl
Boy or girl
How many coaches could you host?
*
Seleccione
1
2
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?
*
Seleccione
Yes
No
Hosting address
*
Street Address
Street Address Line 2
City
State / 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
*
Seleccione
1
2
3
4
5
How many children (under 16 at the time of the program) will be interacting/living in the house with our student
*
Seleccione
1
2
3
4
5
ADULT 1 - FULL NAME
*
ADULT 1 - AGE
*
ADULT 1 - GENDER
*
Seleccione
MALE
FEMALE
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
*
Seleccione
MALE
FEMALE
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
*
Seleccione
MALE
FEMALE
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
*
Seleccione
MALE
FEMALE
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
*
Seleccione
MALE
FEMALE
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
*
Seleccione
MALE
FEMALE
CHILD 1 - AGE AT THE TIME OF THE PROGRAM
*
Seleccione
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CHILD 1 - DATE OF BIRTH
*
-
Mes
-
Día
Año
Fecha
CHILD 1 - IS THIS CHILD ATTENDING THE PROGRAM?
*
Seleccione
YES
NO
NOT SURE YET
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
*
Seleccione
MALE
FEMALE
CHILD 2 - AGE AT THE TIME OF THE PROGRAM
*
Seleccione
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CHILD 2 - DATE OF BIRTH
*
-
Mes
-
Día
Año
Fecha
CHILD 2 - IS THIS CHILD ATTENDING THE PROGRAM?
*
Seleccione
YES
NO
NOT SURE YET
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
*
Seleccione
MALE
FEMALE
CHILD 3 - AGE AT THE TIME OF THE PROGRAM
*
Seleccione
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CHILD 3 - DATE OF BIRTH
*
-
Mes
-
Día
Año
Fecha
CHILD 3 - IS THIS CHILD ATTENDING THE PROGRAM?
*
Seleccione
YES
NO
NOT SURE YET
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
*
Seleccione
MALE
FEMALE
CHILD 4 - AGE AT THE TIME OF THE PROGRAM
*
Seleccione
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CHILD 4 - DATE OF BIRTH
*
-
Mes
-
Día
Año
Fecha
CHILD 4 - IS THIS CHILD ATTENDING THE PROGRAM?
*
Seleccione
YES
NO
NOT SURE YET
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
*
Seleccione
MALE
FEMALE
CHILD 5 - AGE AT THE TIME OF THE PROGRAM
*
Seleccione
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CHILD 5 - DATE OF BIRTH
*
-
Mes
-
Día
Año
Fecha
CHILD 5 - IS THIS CHILD ATTENDING THE PROGRAM?
*
Seleccione
YES
NO
NOT SURE YET
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?
*
Seleccione
No
1
2
3
4
+4
Are any of your dogs considered as a RESTRICTED BREED IN THE COUNTRY?
*
Do you have cats living in the house?
*
Seleccione
No
1
2
3
4
+4
Do you have any other pets in the house?
*
Tell us more information if needed:
How did you hear about us?
*
Please Select
My soccer club
Social media: Facebook, Instagram, ...
Family, friends, ...
Radio
Other
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.
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