Applicant/Spouse
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| Applicant First Name / Last Name: |
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Spouse First Name / Last Name: |
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Applicant Date of Birth:
(dd/mm/yyyy) |
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Spouse Date of Birth:
(dd/mm/yyyy) |
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| Residence Type: |
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Bedrooms |
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| Home Address (FULL ADDRESS): |
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| Guard Gated Community? |
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Community Fitness Center (or within walking/biking distance)? |
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| Applicant’s Native Language: |
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Spouse’s Native Language: |
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| Primary Language Spoken in your Home: |
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| Applicant’s Cell Phone: |
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Spouse’s Cell Phone: |
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| Applicant’s Email: |
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Spouse’s Email: |
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| Applicant’s Employer: |
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| Occupation: |
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Work Phone: |
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| Spouse’s Employer: |
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| Occupation: |
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Work Phone: |
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| Applicant / Spouse’s Facebook URL: |
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Applicant / Spouse’s Skype Account Name: |
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Please provide the following information for other family members / persons living in your home:
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| Adult First Name / Last Name : |
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Date of Birth
(dd/mm/yyyy) |
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| Employer: |
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Relationship to Host Family Applicant: |
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| Occupation: |
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Work Phone: |
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| Adult First Name / Last Name : |
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Date of Birth
(dd/mm/yyyy) |
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| Employer: |
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Relationship to Host Family Applicant: |
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| Occupation: |
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Work Phone: |
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| Child First Name / Last Name : |
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Date of Birth
(dd/mm/yyyy) |
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| Child First Name / Last Name : |
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Date of Birth
(dd/mm/yyyy) |
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| Do you have any Pets? |
If yes, then please provide the following information: |
| Type |
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Kept |
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| Type |
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Kept |
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| Does anyone in your home smoke? |
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| Would you be able to provide transportation? |
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Would you be willing to assist athlete if he/she would need to establish a bank account and/or purchase a cell phone? |
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Accommodation Details
Each athlete will require a private or shared bedroom, along with bedding, dresser, and a reliable high-speed internet service.
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| How many athletes can you accommodate? |
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I / We prefer |
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Available Bedroom #1 |
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Is there a TV in the bedroom? |
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| Available Bedroom #2 |
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Is there a TV in the bedroom? |
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| Available Bathroom |
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If you would host one athlete and have selected a Shared Bathroom, then what is the gender of person to be shared with? |
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| What is the walking distance from your home to the nearest public shopping area? |
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Is there an available parking space in the event that an athlete would have use of a car? |
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Please provide the following information about your family’s interests and routine:
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| Why would you like to host an athlete? |
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Is there beneficial information to know about you or your family in order to make a compatible match? |
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| Please describe yourself and / or your family’s interests: |
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Do you regularly prepare dinner in the evening? What kind of meals do you prepare? |
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| How will you integrate your athlete in your daily / weekly activities? |
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How did you hear about Homestay Florida’s Athlete Program? |
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Please provide two character references. These must be personal, non-familial references who have known you for at least five years.
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| Name |
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Phone |
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| Name |
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Phone |
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| I/We acknowledge that I/We understand the importance of communicating in English if/when possible during the time that my/our athlete(s) are in our home. |
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| I/We acknowledge that I/we, along with any other adult(s) over the age of 18 living in the home, will be required to submit to a Criminal Background Check prior to athlete placement. I/We also acknowledge that I/we will notify Homestay Florida if any adult(s) over the age of 18 moves into the home following athlete placement. |
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| I/We acknowledge that we will be required to complete IRS form W-9 prior to athlete placement. Payment will be provided to us directly from Homestay Florida. |
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| I/We maintain Homeowner’s Insurance or Renter’s Insurance, and I/We agree to ensure that this policy is inclusive of incidents caused by boarders. |
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| I/We acknowledge that I/we will maintain a valid driver’s license and an active auto insurance policy. |
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| I/We have read and understand the Host Family "Homestay Requirements," "Guardian Responsibilities," "Stipend and Conditions," and "Homestay Guidelines" website pages for hosting an athlete. I/We also understand and acknowledge that Homestay Florida is not responsible for any accidents, damages or loss incurred by us as a result of negligence of the athlete and we will negotiate this with the athlete directly. |
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| Declaration |
"I verify that the information on this form is true and correct to the best of my knowledge." |
| Electronic Signature & Date |
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Should you have any questions regarding Hosting or the Registration process, please feel free to text Beth McMahon at 954.650.3668.
