Host Family Enquiry

Guardian 1 Information (required)

Guardian 1 Name *

First

Last

Date of Birth *

Email *

Phone *

Occupation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Guardian 2 (if applicable)

Guardian 2 Name

First

Last

Date of Birth

Phone

Occupation

Student Preference *

Male
Female
No Preference

Wifi in the home *

Can you accommodate a student with special dietary requirements? (Coeliac, Vegetarian, Vegan) *

Do you have any pets? (If yes, please specify) *

Specify Pets

Are you a smoking or non-smoking family? *

Smoking
Non-smoking

Could you accommodate a student that smokes? *

Have you a carbon monoxide alarm fitted in your home? *

Have you a working smoke alarm fitted in your home? *

Have you had your gas boiler serviced within the last 12 months? *

Child 1 Details

Child 1 Name

Child's Date of Birth

Childs gender

Male
Female

child's Interests and Hobbies

Child 2 Details

Child 2 Name

Child's Date of Birth

Childs gender

Male
Female

child's Interests and Hobbies

Additional Children

Please provide details for any other children in the home below

Hosting Availability

Type of Hosting (Select either or both) *

SHORT–TERM (Summer Short-Stay or Winter Short-Stay)
LONG-TERM (School Term or Academic Year)

Family Holidays Planned (provide details below)

Dates Unavailable (provide details below)

Accommodation Available (Please note: A single room with a desk and lamp is required for High School Programmes)

Single Room *

Single Room With Ensuite *

Double Room *

Double Room With Ensuite *

Shared Twin Room *

Number of IELA stundets you can host *

Do you host students from other organisations?

Walking distance from home to nearest transport links: Bus, Train, Dart (in minutes walk) *

Have you been Garda vetted as a host family in the past 2 years? *

If yes please provide reference number

Host Familiy Application

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