Students seeking a Home Stay
Please complete all relevant information and return as an attachment to e-mail.

1. What is your age?

_________________________________

2. What is your gender?

_________________________________

3. What is your Nationality?

_________________________________

4. Do you mind living in a household with young children?

_________________________________

5. What are your food preferences (likes/dislikes)?

_________________________________

6. Do you suffer from allergies, and if so what are they?

_________________________________

7. Are you currently taking any medications?

_________________________________

8. Will you be attending High School, College, ESL, etc?

_________________________________

9. What is your address, and whom would we contact in case of some kind of emergency?

_________________________________

10. Do you mind living with pets?

_________________________________

11. Do you smoke cigarettes?

_________________________________

12. Do you prefer a smoking or non-smoking environment?

_________________________________

13. Will you occasionally be preparing your own meals ?

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Thank you.

Global Lodgings
11 December 2005