Homestay Family Application     

 

             Simone Kossendey                          Homestay Co-ordinator

                                                                  37 Frank Street                                  Ph:

                                                                  KIRWAN                                Mobile:   0405944580

                                                                 QLD 4815                         Email:     homestaytsv@gmail.com

 

Host Family Name:

 

Given Name(s):

 

Home Phone No.:

 

Mobile No.:

 

D.O.B:

 

Occupation:

 

Email Address:

 

Host Partners’  Name:

 

Given Name(s):

 

Home Phone No.:

 

Mobile No.:

 

D.O.B:

 

Occupation:

 

Email Address:

 

 


Residential Address:

 

Post Code:

 

 

Describe your hobbies and interests:

 

Sports played current and past:

 

 

Partner, describe your hobbies and interests:

 

Sports played current and past:

 

 

Host ‘s Nationality:     ______________________________________________________________________________________________________

 

Partners Nationality:  ______________________________________________________________________________________________________

 

Is English the main household language?     Yes / No

 

Do any members of the family speak another language?    Yes / No                                   If so what language?  ______________________________

 

Does any household member smoke?          Yes /  No                                                         Inside / Outside          ______________________________

 

 

Do you own your home / rent?

 

 

Do you have Home and Contents insurance?                                   Yes / No

 

Does your home insurance policy cover you for public liability?       Yes / No

 

Name of company:                                                                             Policy No:                                                  Expiry date:

 

 

Do you have any fire safety appliances in your home / apartment?  e.g. Smoke alarms:

 

 

Do you have a pool compliance certificate?   Yes / No

 

Does your family attend church regularly?     Yes / No        Where, please state:

 

Details of any Pets:

Indoor

Outdoor

 

 

 

 

 

 

 

 

 

 

 

Please list family members/ people living in your house:

Name:

 

¨ Male  ¨ Female

DOB:

____ /  ____ / ____

Hobbies/Interests:

 

Name:

 

¨ Male  ¨ Female

DOB:

____ /  ____ / ____

Hobbies/Interests:

 

Name:

 

¨ Male    ¨ Female

DOB:

____ /  ____ / ____

Hobbies/Interests:

 

Name:

 

¨ Male  ¨ Female

DOB:

____ /  ____ / ____

Hobbies/Interests:

 

Others living in your home:

Name:

 

¨ Male  ¨ Female

DOB:

____ /  ____ / ____

Relationship:

 

Nationality:

 

Hobbies/Interests:

 

Name:

 

¨ Male   ¨ Female

DOB:

____ /  ____ / ____

Relationship:

 

Nationality:

 

Hobbies/Interests:

 

 

Suitability Check:

(All people over 18 years who live or frequently visit this home are required by law to have Blue Card.)

Suitability (Blue Card) details below:

Name:

 

Card Number:

 

Expiry:

 

Name:

 

Card Number:

 

Expiry:

 

Name:

 

Card Number:

 

Expiry:

 

Name:

 

Card Number:

 

Expiry:

 

Name:

 

Card Number:

 

Expiry:

 

Name:

 

Card Number:

 

Expiry:

 

Please attach copies of your blue cards to this application

 

Travel & Transport Details:

Approximate distance from your house to the Educational facility:

 

Most likely means of transportation to the Educational facility would be:

School Bus / Public Bus                 Car                 Foot             Bike

Details of Bus Route:

 

Your house to the bus stop:

 

PLEASE NOTE: All transport details (i.e. Pricing, routes, buses, paths etc.) MUST be provided to the student(s) prior to arrival unless host is          

                            advised otherwise. 

 

Home Details:

No: of bedrooms

 

No: of bathrooms:

 

Lounge

Dining Room

Study

Rumpus Room

Kitchen

Pool

Please Tick

Other facilities:

Student’s Room 1 has:

No: of Beds:

 

Wardrobe

Chest of Draws

Fan

Please Tick

Bedside Table

Shelving

Air-Conditioner

Desk and Chair

Other features:

Student’s Room 2 has:

No: of Beds:

 

Wardrobe

Chest of Draws

Fan

Please Tick

Bedside Table

Shelving

Air-Conditioner

Desk and Chair

Other features:

Does the student have internet or wireless access?         Yes / No                   (Please Circle)

List the facilities available for students use: (i.e. Musical instruments, pool, gym equipment, local parks, shopping centers etc.)

 

_______________________________________________________________________________________

_______________________________________________________________________________________

 

 

Preferences:

Please list any preferences:

Length of stay: 

    Long Term                               Short Term                                                       Both

Age:

   Younger than 15 years             Older than 15 years                                         Adult                                                   Any

Gender:

    Male                                         Female                                                            Either

 

Banking Details:

This information will be used by Homestay Townsville Australia to deposit the funds directly in to your account only.

Bank Name:

 

Account Name:

 

BSB Number:

 

Account Number:

 

Applicants Signature:

 

Dated:

 

 

 

Signature:  ___________________________________________________    Date:   __________________________

 

Signature:  ___________________________________________________    Date:  __________________________

 

A registration fee of $20 for administration expenses is required to be forwarded to Homestay Townsville, Australia with this application before the home inspection is arranged. An invoice will be sent with all details.

OFFICE USE ONLY

Application Received:

____ /  ____ / ____

Date Registration Fee ($20) Recieved :

____ /  ____ / ____

Suitability Card Copies Attached :

YES  /  NO

Date Registration Fee Receipt Sent:

____ /  ____ / ____

Database Entry Date:

____ /  ____ / ____

Inspection Date:

____ /  ____ / ____

Signature Accommodation Officer:

 

Date:

____ /  ____ / ____

   Host Family Registration Procedures:

 

 

Step 1 - Complete Registration Form

 Complete the Family Registration Application form, then print and FAX or scan the completed form back to us.    Fax: 47737667 / homestaytsv@gmail.com

 

                                  Fax No: 4773 7667.                         

     ?

    

Step 3 – Clearances

Once you have completed your application, you will receive a Working With Children Check application number. Please inform Homestay Townsville Australia of this number to so we can verify that you have a valid application in progress

Step 2 - Complete The Working With Children Check Form

Form “”Please refer to http://www.bluecard.qld.gov.au/pdf/forms/PSBA001MAY15-BC-Blue-card-application.pdfQuick links on right hand side of page) Blue Card application (BC) form. Host families are classified “”Volunteers)

 

Step 4 - Form Approval Process

Once your application has been processed, you will be notified of the outcome by email (or post if you do not have an email address). There are only two results of a Working With Children Check – a clearance or a bar.

.

     

 Step 5 - Home Visit

While  we are waiting for clearances (Blue Card approval), we’ll arrange a home visit to view  the bedroom(s) available for students and the common areas of the home.

We have policies and procedures i.e. Risk Management, Child Protection and a Code of Conduct to read and signed.  These will be given to you at the home visit.

    

Step 6 - Student Placement

The home visit has been completed; we can look at placing students with you. This can take some time, as we need to make sure we find the best match between students and hosts.

       

 

 

 

Important Notice:

 •The "Working with Children Checks"  Blue Cards are necessary  for  those 18years and over  living in the house

• DO NOT POST THIS FORM AWAY UNTILL  ALL HAS BEEN SIGHTED,  COMPLETED SECTION B AND SIGNED  BY THE

     HOMESTAY    CO-ORDINATOR

•Home visits are usually conducted on week days or  evenings, depending on the families schedule.

•Student numbers do fluctuate and we can never guarantee that we will be able to place a student with 

  every family 

  •We will only contact families when we have potential students requesting homestay in the area.

PLEASE CONTACT ME ASAP WHEN ALL THE FORMS HAVE BEEN FILLED IN.

 

 

•We will only contact families when we have potential students requesting homestay in the area.

 

 

 

 

 

 

 

 


If you are a current holder of a Blue Card please enclose a copy of all family members CARDS with the forms