Host Family Form

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Host family application form

Surname

En Suite Facilities

First Name

Wash hand basin

Marital Status

No Carpet

Occupation

Partner's Name

Availability

June July August
If you have holidays booked please specify dates:

Marital Status

Are you willing to host

	Yes	No
A group leader
A vegetarian
A smoker

Occupation

Is smoking permitted in your house

Yes No

Address

Does anyone smoke in your house

Yes No

Home Tel

Do you have family pets

Yes No

Work Tel

If yes please give details

Mobile Tel

Other facilities

Piano Computer

Fax

Number of bathrooms ( incl ensuite)

Children living at home(if any): names and years of birth

Previous hosting experience (if any)

Public Transport to/from Holy Child Sallynoggin

E-Mail

Student preferences
(if any)

	8-11	12-14	15-17	18+
Male
Female
Either

We wish to apply to accommodate a student attending LAL and we agree to the conditions attached.
Date

Language and Leisure, Clarinda Lodge, 30 Clarinda Park West, Dun Laoghaire, Co. Dublin, Ireland.
Tel +353-1-280 4586 Fax +353-1-2805424 E-mail info@lal.ie