Chippewa Steel Hockey Host Family Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Host Father Phone Number
-
Area Code
Phone Number
Host Mother Phone Number
*
-
Area Code
Phone Number
Host Father Email
example@example.com
Host Mother Email
*
example@example.com
Host Father Occupation
Host Mother Occupation
Children (living in the home) - Name(s), Gender, Age
*
Who else lives in your home with you (in addition to a spouse or children previously listed)?
*
How much travel is required by host family's employer(s)?
*
Little to None
Some
Frequent
Does either parent work or run a business from home?
*
Have you ever hosted a player or exchange student before?
*
If you hosted two players, would each player have their own room?
*
Yes
No
Describe accommodations available to a player in your home.
*
In addition to a permanently assigned player, would you be willing and able to house an additional player on a temporary/short term basis(player in town on tryout, other billet family out of town, etc.)?
*
Yes
No
USA Hockey guidelines stipulate background checks to be conducted on all families that are part of our housing program. Would you object to having a background check on you and your family?
*
Yes
No
The following questions will be used solely to help match players with host families. Each year there are a number of players who have specific requests about housing families, and we try our best to accommodate those requests. This information will not be used when selecting host families for the year, it is solely for matching purposes.
What kind of pets are living in your home? If none enter none.
*
Does anyone in your house smoke?
*
Yes
No
Does anyone smoke inside your house?
*
Yes
No
Does anyone in your family drink alcohol? If so how often?
*
Do you have a regular meal schedule?
*
Yes
No
Within which school district do you live?
*
Do you have wireless internet access in your house?
*
Yes
No
What chores would the player be responsible for?
*
What house rules would you like to mention at this time?
*
What is our opinion on players drinking, smoking, or disregarding Team policy in your home?
*
Will you notify the Billet Coordinator if there are any concerns with your player of if the player is involved in any rule violations?
*
Yes
No
Would you be supportive if the player living with you were to be traded? Would you be willing to take a new player?
*
Would you be able to give the player enough personal space and refrain from asking questions about the team or “coaching” him on his game?
*
Yes
No
USA Hockey, NAHL and the Chippewa Steel all require an in-home visit by the Billet Coordinator or Coach. Would you oppose this?
*
Yes
No
What questions or comments do you have at this time?
*
Submit
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