Host Family Application Form - Horner School of English

OFFICE USE ONLY !

Test

1. Personal Details & Contact Information

If you are located on a direct bus route stopping nearby Horner School of English or living near to a DART station then we would love to speak to you. Ideally we are looking for host families within a 45 minute (door to door) travel distance to Fitzwilliam Street Upper.

Family Name (Surname)

Last

Wife's First Name

Husband/Partner First Name:

Wife's Date of Birth

Husband/Partner Date of Birth

Wife's Occupation

If retired please state previous occupation.

Husband's Occupation

If retired please state previous occupation.

Family Address

Street Address Address Line 2 City ZIP / Postal Code

Email

Mobile Phone

Home Phone

Number of Children Living at Home

Name (Child 1)

First

Gender (Child 1)

Male
Female

Date of Birth (Child 1)

Name (Child 2)

First

Gender (Child 2)

Male
Female

Date of Birth (Child 2)

Name (Child 3)

First

Gender (Child 3)

Male
Female

Date of Birth (Child 3)

Name (Child 4)

First

Gender (Child 4)

Male
Female

Date of Birth (Child 4)

DD

MM

YYYY

2. Facilities & Environment

How Many Bedrooms Do You Have Available

Please enter a number from 1 to 3.

Room 1 (Room Type)

Room 1 (Contents)

Study Desk
Chair
Study Lamp
Wardrobe
Wood Flooring
Carpet

Room 2 (Room Type)

Room 2 (Contents)

Study Desk
Chair
Study Lamp
Wardrobe
Wood Flooring
Carpet

Room 3 (Room Type)

Room 3 (Contents)

Study Desk
Chair
Study Lamp
Wardrobe
Wood Flooring
Carpet

Do You Have Wi-Fi At Home ?

Yes
No

Do You Have Any Pets:

Yes
No

Please list the type of Pets

Are There Any Smokers in Your Home

Yes
No

If Yes, do you allow anyone to smoke inside the house ?

Do You Have an Ensuite Bathroom Available For Students

If any of the bedrooms (which you offer to students) has a bathroom within the room, please tick yes to this question.

Yes
No

Do You Have a Private Bathroom Available for Students

A bathroom (separate to a family bathroom) which would be for the sole use of your student/s.

Yes
No

If yes please describe what is available

Do You Have a Car

It is sometimes necessary to collect (group students) from a central meeting point (arrival /departure)

Yes
No

Does Anyone in the Family Play a Musical Instrument

We sometimes have students who ask to stay with a musical host family.

Yes
No

What Instrument/s are played

Does Anyone in the Family Play Sports

We sometimes have students who ask to stay with a host family with an interest in sport.

Yes
No

What Sports are Played

3. Hosting Preferences

Can You Cater For Any of These Special Diets

Vegetarian
Vegan
Lactose Intollerance
Celiac / Gluten Free Diet
Diabetic

Which Months Of The Year Will You be Available to Host Students

Any Other Information you Wish to Add

Age group & gender that you would prefer to host. Etc.

4. Transport Details

Please tell us about the Bus Routes That Serve the City Centre

Click on the + symbol to add more than one bus route

Bus Number	Walking Distance to Bus Stop (Minutes)	Journey time to City Centre

Please tell us about the DART/TRAIN/LUAS That Serve the City Centre

Click on the + symbol to add another DART or LUAS Route

DART or Luas ?	Walking Distance to Station (Minutes)	Journey time to City Centre

4. Please read the terms & conditions and tick the consent box below:

If you meet the criteria to become a host family, a member of our Accommodation Team will contact you ASAP to arrange a visit to your home and discuss with you in more detail about your application.

TERMS & CONDITIONS CONSENT*

MINIMUM REQUIREMENTS FOR ANY FAMILY WISHING TO HOST A FOREIGN STUDENT
The following guidelines are laid down by the Department of Education and all schools recognised by ACELS for the teaching of English as a foreign language are required to adhere to them. Please retain these guidelines for your future reference.

1. ACCOMMODATION (Your house should have):
•Central heating
•A shower available to the students
•Hot water available every morning and evening

Each student’s room should contain:
•A desk
•A wardrobe
•A study lamp
•A window

2. MEALS:
In order for the student to feel like part of the family, he/she should never be left to eat alone. The evening meal should be taken with the family. All students require a continental breakfast and hot evening meal daily. All students require lunch at the weekends. Meals should vary from day to day.

3. PROVISIONS:
Each student should be provided with:
• A fresh set of hand and bath towels at least once weekly.
• A fresh set of bed linen at least once weekly

4. LAUNDRY:
• You should cater for a minimum of one laundry wash per student per week
• Students are advised that you will not hand-wash clothes, or be responsible for delicate clothes, heavy jumpers etc.

5. NUMBER OF STUDENTS:
• At any one time, you may only have one student of each mother tongue (unless notified by the Horner School of English) living in the house.
• You may never host more than three students simultaneously.

6. LEAVING STUDENTS ALONE:
Under no circumstances should the host family go on holidays during the period in which they have students. Please let us know of any holiday plans and we will avoid placing students during this period.

7. TRANSFERS ON ARRIVAL AND DEPARTURE:
Horner School arrange transfers to/from Dublin Airport using the services of a specialist transport company. We do not expect host families to collect students at the airport on arrival or to return students to the airport on departure.

If the student is coming as part of a group, we will bring the group to a central meeting point and will ask you to collect your student from that location. Payment for this is included in the rate we give you.

8. RECONFIRMATION OF ARRIVAL:
We will contact you in the week before your student is due to arrive, to reconfirm all arrangements. If you do not hear from us by the Wednesday (of the arrival week), we would ask you to telephone us to reconfirm all the arrival details.

9. CURTAILMENT:
In the unlikely event that a student must leave your home earlier than the planned departure date (for whatever reason), then it is important to understand that you will be paid for the exact number of nights hosted.

10. BOOKING EXTENSION:
If a student requests to remain in your home longer than the original booked dates of stay the student must be referred back to the Horner School office to make a NEW Accommodation booking. Horner School will first check with you, if you are available to accept the student for the new extension dates. Horner School will accept payment directly from the student for the new booking period.

11. PAYMENTS:
Host family payments are made from Horner School of English to the Host Family, by Bank Transfer every 4 weeks or at the end of your students stay, if less than 4 weeks.

Name

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