Host Family Registration Form
OKC Homestay
Host Parent 1
Name
*
Title
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
E-mail
*
Phone Number
*
Occupation
*
Working With Children Check
WWCC Number
Host Parent 2
Name
Title
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
E-mail
Phone Number
Occupation
Working With Children Check
Family Members
Rows
NAME
GENDER
DATE OF BIRTH
RELATION
OCCUPATION
1
2
3
4
5
6
7
Address
*
Street Address
Street Address Line 2
City
State
Postal Code
How many rooms for student?
*
Do you have Wi-Fi?
*
Yes
No
Any Pets?
*
None
Dogs
Cats
Birds
Other
Student Gender preference?
Any
Male
Female
Duration preference?
Any
Short (within 6 weeks)
Long
Experience?
Never
Less than 3 Students
3 - 10 Students
10 - 50 Students
Over 50 Students
Message for student
Photos
Upload a file (optional)
Please provided some photos of host family and exterior of the home.
Cancel
of
SEND
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