HOST FAMILY APPLICATION | Marion Berries

First & Last Name

Phone

Email

Address

City, State

Zip Code

What type of housing do you live in?

Apartment

House

Other

Married or single? Please include the names and ages of any other household members.

Do you have pets?

Yes; indoor pets

Yes, outdoor pets

No

If you own pets, please list the type of pets and how many below.

Please describe the accommodations you have for a potential player (individual bedroom, individual bathroom, shared bathroom, etc.)

How far do you live from Bush's Pasture Park? (in minutes)

Will the players need a vehicle or are you able to assist with transportation?

What will the player(s) have access to? Select all that apply.

Washer

Dryer

Kitchen

Have you been a host family or hosted an exchange student before?

Why would you like to host a player?

What hopes/expectations do you have for the player you are hosting? (Participating in family activities, purchasing their own food, overnight guests, etc.;

What else would you like us to know about your family/home?

Have you or anyone currently residing in your home been convicted of a misdemeanor or felony?

Yes

No

I hereby certify that the information in this application is true to the best of my knowledge. I understand that deliberate falsification or omission of this information will preclude me from serving as a volunteer.

Signature field is empty.

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