Home Stay Family Expression of Interest

Please give brief comment as to why you would like to host an international student.*

Host Parents

Parent 1 First Name *

Parent 1 Surname Name *

Parent 1 Gender *

Parent 1 D.O.B. *

(dd-mm-yyyy)

Parent 1 Occupation *

Parent 1 Nationality *

Parent 1 Cell Phone Number

Parent 1 Work Phone *

Parent 1 E-mail address *

Parent 2 First Name

Parent 2 Surname Name

Parent 2 Gender

Parent 2 D.O.B.

(dd-mm-yyyy)

Parent 2 Nationality

Parent 2 Occupation

Parent 2 Cell Phone

Parent 2 Work Phone

Parent 2 E-mail address

Contact Information

Home Phone Number *

Number and Street Name

Suburb

City

Zipcode/Postcode

Host Family Members

Child Name 1

Child Gender 1

Child D.O.B 1

dd-mm-yyyy

Child Name 2

Child Gender 2

Child D.O.B 2

dd-mm-yyyy

Family Details

Is English the first language spoken at home

If no, please state your first language Other languages spoken in the home

Does any member of your family have an existing medical condition that an international student should be made aware of?

(e.g. epilepsy)

If yes, please state which family member and medical condition

What is your family’s main religion:

(e.g. CATHOLIC)

Do any of the household members smoke?

Do you have any pets in your home?

If yes, please list pet types

Are you able to cater for students with food allergies (eg. Peanuts)?

Please list any special dietary restriction (e.g. vegetarian) in your home which may affect students we place with you

Are you able to cater to the requirements of Muslim students?

General family lifestyle

Which option best describes your family?

We are a quiet family who prefer the comfort of home in our spare time.

We are an active family who prefer to be out doing activities away from home during our spare time.

Do you currently host students from other language School/Providers

If so, which other school?

What is the preferred age of the student that you would like to host?

Do you prefer a host student that is (gender)

Student Bedroom 1 is

Student Bedroom 2 is

Bathroom facilities

Will you provide Internet access?

How will the student travel to and from school each day?

Distance from your home to bus stop / train station?

Bank Account Details

Account Name:

Account Number:

Contact Us

Phone +64 9 831 0500

Massey High School
274 Don Buck Road
Massey
Auckland 0614
New Zealand

Massey High School

Seek the Heights

Excellence - Equity - Respect - Integrity - Community