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Irish Home Stay Application
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Individual Stays (new)
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Irish Home Stay Application Form
APPLICATION FORM
(All answers in BLOCK CAPITALS - in black biro)

Insert Photo:

 
Surname: ________________________________________
Christian Name: ________________________________________
Date Of Birth: ________________________________________
Address: ________________________________________
________________________________________
________________________________________
________________________________________
Home Phone: ________________________________________
Email Address: ________________________________________
Name Of School: ________________________________________
Name Of French Teacher: ________________________________________
No Of Years Learning French
(up until June 12):
________________________________________
Father's/Mother's Occuption: ________________________________________
Number Of Brothers? ____________     Ages __________
Number Of Sisters? ____________     Ages __________
Where does your family live? ________________________________________
Please tick the appropriate: Town()   Village()    City()   Suburbs()   Farm()  Country()
Interest & Hobbies: ________________________________________
________________________________________
Type of Character? Shy()
Outgoing()
Confident()
EasyGoing()
Determined()
Group Preferring? Group I()  Group II()
Health Problems
(If Any)?
________________________________________
Other Comments ________________________________________

Parents Signature ________________________________________

 
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