Host family Application

First Name
Last Name
Mother's First
Father's First
Marital Status
Address Continued
Zip Code
Home Telephone
Father's Age
Father's Occupation
Work Telephone
Cell Phone
Mother's Age
Mother's Occupation
Work Telephone
Cell Phone
First NameMale/FemaleBirth dateLiving at home?
Swimming Mountaineering Movies
Sailing Windsurfing Jogging
Theater Camping Classical music
Modern Music Fishing Gymnastics
Tennis Cooking Dance
Golf Shopping Concerts
Equestrian Photography Museums
Soccer Video games Reading
Cycling Web surfing Painting & Drawing
Basketball Chess Musical instrument
Baseball/Softball Collecting
Who will be the main companion(s) for your exchange student?
Will your exchange student have the opportunity to meet others their own age?
Is smoking allowed?
Outdoors only
Do you have a religious affiliation? If yes, thanks for indicating which one
Do you attend church
Do you live
Do you have pets at home? If so please indicate what kind
If anyone belongs to a club, organization or a team, please indicate which one(s) and the name of the family member(s) involved