It Is Very Important That You Complete All of This Questionnaire
Total Page：16
File Type：pdf, Size：1020Kb
THIS FORM MUST BE COMPLETED IN FULL
Main Homestay Carer (Please circle: Wife, Husband, Partner)
Title …………… First Name…………………………………. Last Name…………………………………….…..
Date of birth …………………… Occupation …………..………………… DBS No………………………….. (A copy of your valid current DBS is required) Address ………………………………………………………………………………………………………………….. ………………………………………………………………………POST CODE:………………………………..…….
Home……………………………………………. Work ……………………………………….…….…..
Mobile ………………………………………… Email ………………………………………...………………... ______
nd Details 2 applicant: (Please circle: Wife, Husband, Partner)
Title …………… First Name…………………………………. Last Name…………………………………….…..
Date of birth …………………… Occupation …………..………………… DBS No………………………….. (A copy of your valid current DBS is required) Mobile …………………………………………
Children living at home: CHILDRENS’ NAMES Gender (M/F) DATE OF BIRTH ……………………………………………………. ………… …………………...
……………………………………………………. ………… …………………..
……………………………………………………. ………… …………………… Other persons living with you Is there any other person/s living with you other than the above? If so, please state name, age and if that person is a friend/relation etc.
NAME……………………………………… DOB……………… Relationship to you ………………………..……..
DBS No…………………………..(A copy of your valid current DBS is required)
As a family what are your hobbies/interests? ……………………………………………………………………. ……………………………………………………………………………………...……………….……………………...
Do you accept other paying guests/students? Yes No
Do you smoke? Yes No Do you allow smoking outside? Yes No
What is the main language spoken in your home? …………………………………………………..………
What is your religion?………………… Please confirm your mother tongue ………………………....
Do you have any pets – if yes, please give details of pets and how many? ………………………………………………………………………………………………………………………….
Are you available for summer students (from mid June)? Yes No Describe your home: (Please circle) House Flat Maisonette Bungalow Other…………….
How many bedrooms do you have available for students?
Single Room…… Twin Room…....(state if with bunk beds) Double Room with double bed…...
En suite room…………
Do you accept? Male Female Either
Will you cater for special diets e.g. vegetarians, coeliac, halal ? Yes No
Is free Wifi available for your students? Yes No
Do you accept junior students (14-16 years old)? Yes No
Do you wish to host students from Groups: Yes No Group students will require picking up and dropping off at an arrival and departure meeting point.
Do you agree not to: (this is part of the school accreditation requirements) Not to host adult students (18+) at the same time as hosting junior students (under 18). Not to host more than 4 students at any one time from any school. Not to host students speaking the same language (i.e. 2 or more French speaking students) Not to mix the gender of junior students, i.e. you will not host male and female junior students. I agree with the above requirements Yes I do not accept the above requirements No
We require all homestay families to complete the Care of Junior Declaration on an annual basis, copy attached.
New legislation requires that a GAS SAFE registered engineer should service all homestay gas central heating systems and all homestay families must hold a Landlord’s Safety Certificate. Please ensure the school has an up to date copy.
Please enter the name and address of your doctor, in case of emergency: Name of Doctor & surgery………………………………………………………………………………………….
Surgery Address:……………………………………………………………………………………………………
Telephone No…………………………………………
Inform the school of any dates you are unable to host.
If there is any further information you think would help the school in placing the right student with you, please indicate below and include any special requests: ………………………………………………………………………………………………………………………………
THE PROVISION OF THE CHILDREN ACT 1989 REQUIRES US TO CHECK ALL STAFF/FAMILIES FOR CRIMINAL RECORDS. Please note that it is now a requirement to hold a valid DBS disclosure for the main carer as a minimum in order to host students under 18 years. If you haven’t been checked yet you must be willing to cover this expense. Please list below people in your household who have a valid DBS certificate. Note the main carer is required to have this certificate and provide a copy to the school. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… Name (please print) ……………………………………………………………………… Signature ……………………………………………………………………… Date ……………………………………………………………………… Please return this form to: Accommodation, The Oxford English Centre, 66 Banbury Road, Oxford, OX2 6PR