HOST APPLICATION

Host Application

PLEASE COMPLETE THE FORM PROVIDING AS MUCH INFORMATION AS POSSIBLE
*If you are running a family Day Care Centre registered or private please contact our office prior to completing the online application.

Location*

Accommodation type*

Personal Details - Main Host

Title*

First Name*

Surname*

Preferred Name*

Date of Birth*

Must be dd/mm/yyyy

Occupation*

Home Phone*

Mobile Phone*

E-mail Address*

Other Languages Spoken*

Religion*

Smoker*

WWCC/BC Number (If known)

WWCC / BC If you have a WWCC / BC please enter the details below

Issue Date

Expiry Date

Address

Street Address*

Suburb*

State*

Post Code*

Current Household Members

Do you have a partner, children, or any other people who live with you? If yes, please add their details below:

Click the box to add child / other resident

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List

Name	DOB	Gender	Relationship	Occupation

Do you have any pets? If yes, click here to add pets

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List

Type of pet	Name	Breed

Hosting Information

Gender preference*

Do you need the student to do their laundry?*

Do you need the student to do household chores?*

Do you have previous hosting experience?*

Type of food cooked in home*

Asian
Kosher
Vegetarian
Gluten Free
Modern Western
Vegan
Halal

Hobbies / Interests*

Home Details

Home type*

Home condition is*

Home is*

Total No. of bedrooms in home*

No. of bedrooms available for students*

Total No. of bathrooms in home*

No. of bathrooms for student use*

Click the box to add student bedroom details

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List

Room no:	Size	Bed size	Bathroom	Occupied	Available date	Room facilities

Other facilities available

Please describe your home*

Please describe the main public transport available from your home*

Payment Details

Homestay Fees are paid directly into your bank account. Please provide details:

Bank

Branch

Account Name

BSB Number

Account Number

Public Liability & Home Content Insurance

Do you have public liability Insurance?*

Name of the Insurer

Policy number

Covered amount

Do you have home contents insurance?*

Name of the insurer

Policy number

Covered amount

Does your policy cover the boarder(s)?

Note: Families taking overseas students must have compulsory public liability insurance.

Declaration

I/We understand the responsibilities and requirements of hosting an international student.
I/We understand that Auzzie Familes Homestay Care attempts to select bona fide students and cannot be held responsible for any undesirable or negligent actions of the student.
I/we approve Auzze Families Homestay Care to collect, hold & work with my personal records solely for the purpose of conducting homestay agency duites.
By providing Auzzie Families Homestay Care with your personal information you consent to us collecting,disclosing,storing & using it in accorance with our Privacy Policy
You have obtained prior consent to supply personal information of any other household members.
We certify the answers given are true and correct to the best of our knowledge.

Please include an email address to send confirmation of this form submission*

By submitting the form, I agree to the above declaration, responsibilities and requirements as advised by Auzzie Families Homestay Care as set out on their website.

Name

This field is for validation purposes and should be left unchanged.

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