Host Family
Date
Date of Arrival Duration of Stay
Name
Last Name First Name
Address
City Country
Tel Fax Email
Personal Information
Day Month Year
Age | Sex Female Male | Nationality
English Level
Beginner Elementary Lower Intermediate Upper Intermediate Pre-advanced Advanced
Interests & Hobbies (check all that apply)

Personality (check all that apply)

Allergies

Special Health Requirements

Do you smoke?
Yes No
Do you have concerns about living in a family with pets?
Yes No
Religion
Yes No Other
Family Members
Name Relation Age