604-498-3233 | info@surreychristian.com | www.surreychristian.com

HOST FAMILY APPLICATION FORM

First Name *

Last Name *

Spouse first name (if applicable)

Spouse last name (if applicable)

Street Address *

Apt./Unit Number

City *

Province *

Postal Code *

Phone Number *

Country *

Email address *

Your birthdate * +

First language *

Occupation *

Are there other people besides yourself who live in your home? *

Yes

No

First name of additional occupant

Last name of additional occupant

Gender

Male

Female

Age

First language

Relationship to you (son, daughter, spouse etc.)

Occupation / School

Add an additional occupant

Yes

First name of additional occupant

Last name of additional occupant

Gender

Male

Female

Age

First language

Relationship to you (son, daughter, spouse etc.)

Occupation / School

Add an additional occupant

Yes

First name of additional occupant

Last name of additional occupant

Gender

Male

Female

Age

First language

Relationship to you (son, daughter, spouse etc.)

Occupation / School

Add an additional occupant

Yes

First name of additional occupant

Last name of additional occupant

Gender

Male

Female

Age

First language

Relationship to you (son, daughter, spouse etc.)

Occupation / School

4 - Add an additional occupant

Yes

First name of additional occupant

Last name of additional occupant

Gender

Male

Female

Age

First language

Relationship to you (son, daughter, spouse etc.)

Occupation / School

Do you own any pets? *

Yes

No

Type and breed of pet(s)

Are you a Christian? *

Yes

No

Name of church that you/your family attends

Why are you interested in hosting an international student? *

Have you hosted an international student previously? *

Yes

No

Describe your home *

Number of levels *

Number of bedrooms *

Number of bathrooms *

Name and describe social areas in your home

Describe the room where the student will sleep

Located on level *

Size (approximate square feet) *

Occupancy *

List/describe the furnishings in the student's room *

Miscellaneous

What are some of the family rules your students should be aware of? *

What family activities would you include your student in? *

What are arrangements such as transportation, food and laundry does your student need to be aware of? *

List two references, not including family members, who we may contact

Reference 1 first and last name *

Reference 1 phone number *

Reference 1 email address

Reference 2 first and last name *

Reference 2 phone number *

Reference 2 email address

EXPECTATIONS OF HOST FAMILY

1. The host family will provide a safe, secure home environment that is Christ-centered for the student(s).

2. The host family will provide consistency between home and school so that the vision of the school is encouraged.

3. The host family members are to be proficient in English and are to speak English when the student is present.

4. The host family shall provide adequate sleeping quarters (bed, desk, dresser, closet).

5. The host family shall provide nutritional, well-balanced meals three times a day (breakfast, lunch, dinner) plus snacks.

6. The host family will provide transportation to and from school if necessary. Transportation to and from various school events should be provided by the host parents as long as it occurs on a reasonable frequency (2-3 times per week) and the student asks politely in advance.

7. The host family should not expect students to do maintenance work in or outside the house, or babysit their children, or cook their meals (unless done together).

8. The host family should be willing to involve the student in family activities.

9. No one in the host family abuses alcohol or drugs.

10. All members of the host family who are over the age of 18 will agree to submit to a criminal record check at their own expense.

11. The host family will notify the school of any unusual incidents as soon as possible.

12. The host family must secure immediate medical attention when necessary, and then notify the school.

13. Under no circumstances shall the student be home alone overnight. If the host family is going away, they are responsible to find a place for their student to stay or to bring someone they approve of into the home to supervise the student. This must be notified to the school in advance.