J.M. New Host Family

Applicationfor new Host Families

If you have hosted for us in the past, please do not fill out this form.

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An asterix (*) indicates a required field.

Please note, that due the current situation with the Coronavirus, we will not do any Home Visits until further notice. If you want to apply as Host Family, we will keep your data in our records and contact you as soon as possible. Thank you for your understanding.

1. MAIN CONTACT DETAILS
Mrs   Mr   Miss   Family
First Name & Surname:*
House No & Street:*
Postcode:* Town Area: -
E-Mail:*
Repeat your E-Mail:*

Your date of birth:*
Landline: 01323-
Mobile:
Nationality:*
married   single   partnered   other
Your Hobbies/Interests:
Your Occupation:
Phone Work:
Your working times from ... am/pm to am/pm days a week.
flexible   shifts
 
DBS checked? Yes No
Please upload the DBS. If you do not have the DBS in copy right now, please click No. Upload
Criminal record? Yes No
 
Best time to contact you at home:* mornings lunchtime afternoon evening

2. PARTNERS DETAILS
First Name/Surname:
Date of birth:
Mobile:
Nationality:
Occupation:
Phone Work:
Working times from ... am/pm to am/pm days a week.
 
DBS checked? Yes No DBS File Upload Upload
Any criminal record? Yes No

3. ADDITIONAL CONTACT FOR EMERGENCIES
Name:
Phone Number:

4. OTHER FAMILY MEMBERS LIVING IN YOUR HOME
1. Name/Year of Birth/Relationship/Sex:
2. Name/Year of Birth/Relationship/Sex:
3. Name/Year of Birth/Relationship/Sex:
4. Name/Year of Birth/Relationship/Sex:
5. Name/Year of Birth/Relationship/Sex:

5. YOUR PAYMENT DETAILS
Account Holder: Mrs   Mr   Miss
Account No/Sort Code:

6. ACCOMMODATION DETAILS
Student Room SB* DB* BB* Floor**
1.
2.
3.
* SB=Single Beds, DB=Double Beds, BB=Bunk Beds
** Ground Floor, First Floor, Second Floor, ...
Which age group/s would you prefer to host? 10-12 13-14 15-16 17-18 19-23 >23
Preferring boys/girls/either?*
Is there a sex or age group you cannot accept under any circumstances?
Would you accept teacher?* Yes No
Would you accept leader?* Yes No



Does any member of your family smoke inside the house?*

Yes No
Do you have any dogs?* No Yes
Do you have any cats?* No Yes
Other pets?


Recommendation by
Home Visit:*

Thank you for applying to be one of our host families. Before we allocate students one of our staff members will need to visit your house to have a look at the rooms and to explain all the details.

Our visits are Mondays to Fridays.

Please tick preferred day and time. We will then contact you to confirm.


Time:
 
 
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