* Family Surname

* Name of Host Parent/s

* Host Mother's Occupation

* Host Father's Occupation

* Homestay Address

* Home Phone Number

* Mobile Phone Number

* Email Address

Working With Children Check Website Link: https://online.justice.vic.gov.au/wwccu/onlineapplication.doj
Under Occupational Field, select Student Exchange Program/Homestay

* 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)

* Are you a Billanook Family?

* Name/s of Children

* Hobbies of Child/ren

* Family Pets

* Internet Access (Yes/No - Type)

* 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

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

* Are you interested in:

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

* 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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