New Host Registration.

Name *

Address *

Suburb *

State *

Zip Code

Mobile Phone *

Email Address *

Female Parent Name / Birth Date / Occupation *

Female Parent WWCC Number. *

Male Parent Name / Birth Date / Occupation *

Male Parent WWCC Number. *

Children living with you now : Name / Gender/ Birth Date / Occupation *

Schools / Universities in your area *

Languages spoken at home *

Is Internet access available in the home *

Total number of student rooms available in your home *

What Languages are spoken in the Home ? *

Is your home an Apartment or a House *

How is your home Heated ? *

What are the Family interests *

Do you have any Pets *

Is your Home a non smoking home ? *

What is the Company name of your Home and Contents Insurance which covers students residing with you ? (Refer to http://www.homestay-australia.com/insurance1.htm ) *

What is the Expiry Date of the Insurance which covers students residing with you ? (Refer to http://www.homestay-australia.com/insurance1.htm ) *

Any International students residing in your home now. If yes, what are their ages and gender *

What Public Transport do you have available within walking distance of your home *

What is the travel time to the city from your home *

Do you prefer a Male or Female student ? *

Do you Agree with our Terms & Conditions. Refer to : http://www.homestay-australia.com/host_family_information.htm *