Family Surname

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* Family Surname

Name of Host Parent/s

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* Name of Host Parent/s

Please select your age range (tick more than one if applicable)

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* Please select your age range (tick more than one if applicable)

Host Mother's Occupation

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* Host Mother's Occupation

Host Father's Occupation

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* Host Father's Occupation

Homestay Address

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* Homestay Address

Home Phone Number

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* Home Phone Number

Mobile Phone Number

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* Mobile Phone Number

Email Address

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* Email Address

Working With Children Check Website Link: https://online.justice.vic.gov.au/wwccu/onlineapplication.doj
Under 'Occupational' field'select Student Exchange/Homestay  Arrangements (Code 78)
Under 'Add an Organisation Name' field, type in Billanook College/International Program, 197 Cardigan Road, Mooroolbark, 3138, 9725 8556
Working With Children Check

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* Working With Children Check

All persons 18 years and over MUST HAVE a Working With Children Check. 
Please advise of any other persons living/lodging (full or part-time) in the homestay residence (eg relative/partner of relative)
Other Person/s living at this Homestay (eg. grandparent, lodger, etc)

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* Other Person/s living at this Homestay (eg. grandparent, lodger, etc)

Are you a Billanook Family?

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* Are you a Billanook Family?

Name/s of Children

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* Name/s of Children

Hobbies of Child/ren

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* Hobbies of Child/ren

Family Pets

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* Family Pets

Internet Access (Yes/No - Type)

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* Internet Access (Yes/No - Type)

Access to Public Transport - please advise if yes

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* Access to Public Transport - please advise if yes

Would you be prepared to host a student who MAY have a significant medical condition eg. diabetes, epilepsy,
anaphylaxis - Yes or No

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* Would you be prepared to host a student who MAY have a significant medical condition eg. diabetes, epilepsy,
anaphylaxis - Yes or No

Billanook College Wellness Centre Nurse will make contact with you to discuss any known significant medical conditions of student/s to be hosted prior to placement.
How did you hear about our Program? Please advise

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* How did you hear about our Program? Please advise

Are you interested in:

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* Are you interested in:

Do you have previous hosting experience?  If yes, please describe.

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* Do you have previous hosting experience?  If yes, please describe.

OFFICE USE ONLY

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* OFFICE USE ONLY

All information on this form will be used and maintained in accordance with College Privacy Policy (www.billanook.vic.edu.au)

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