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Host Family Application Form
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Host Family Application Form
Host Family Application Form
David Horner
2019-10-08T14:15:28+01:00
Host Family Application Form
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
First
Husband/Partner First Name:
First
Wife's Date of Birth
Day
1
2
3
4
5
6
7
8
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29
30
31
Month
1
2
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4
5
6
7
8
9
10
11
12
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Husband/Partner Date of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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)
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name (Child 2)
First
Gender (Child 2)
Male
Female
Date of Birth (Child 2)
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Name (Child 3)
First
Gender (Child 3)
Male
Female
Date of Birth (Child 3)
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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)
Single Room (single bed)
Twin Room (2 single beds)
Double Room (double bed)
Room 1 (Contents)
Study Desk
Chair
Study Lamp
Wardrobe
Wood Flooring
Carpet
Room 2 (Room Type)
Single Room (single bed)
Twin Room (2 single beds)
Double Room (double bed)
Room 2 (Contents)
Study Desk
Chair
Study Lamp
Wardrobe
Wood Flooring
Carpet
Room 3 (Room Type)
Single Room (single bed)
Twin Room (2 single beds)
Double Room (double bed)
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
January
February
March
April
May
June
July
August
September
October
November
December
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
This field is for validation purposes and should be left unchanged.