Please be assured that all information will be sent and retained in confidence. Your details will not be passed on to any third party for any purposes.


Host Family Registration Form
* indicates required fields 
  *Surname:
  *Address:
  *Phone/Mobile:
  *E-mail:
  *Host Mother/Father (name & occupation):
  *Marital Status:  Married
 Single
 Widowed
 Living with Partner
 Other
  Partner/Spouse name & occupation (if applicable):
  *Children (names, ages, living at home?):
  *Family's Hobbies/Interests:
  *Pets at Home?:
  *Family Smokes? (for students with asthma etc.):  Yes, inside the house
 Yes, but only outdoors
 No, but accepts smokers
 No, and doesn't accept smokers
  *How did you hear of us?:  Leaflet
 Search Engine
 Recommended by friend/colleague
 Other
  If selected 'friend/other' - please detail:
  Message/Notes:
  *Room Available:  Twin (2 beds)
 Single
 

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