Your name

Question Title

1. Your name

Street address

Question Title

2. Street address

City

Question Title

3. City

State

Question Title

4. State

Zip Code

Question Title

5. Zip Code

Email address

Question Title

6. Email address

Best phone number to contact you

Question Title

7. Best phone number to contact you

Which country would you prefer to host a Chaperone from?

Question Title

8. Which country would you prefer to host a Chaperone from?

Would you prefer Male, Female or Either?

Question Title

9. Would you prefer Male, Female or Either?

Which age range would work best for your family? (select all that apply)

Question Title

10. Which age range would work best for your family? (select all that apply)

What is your work schedule?

Question Title

11. What is your work schedule?

How many hours a week will at least one spouse be home?

Question Title

12. How many hours a week will at least one spouse be home?

Are you willing to drive your chaperone to meet host families for day outings if necessary?  (You would not be required to stay for the day - just drive to a meeting place.)

Question Title

13. Are you willing to drive your chaperone to meet host families for day outings if necessary?  (You would not be required to stay for the day - just drive to a meeting place.)

What are your interests and/or hobbies?

Question Title

14. What are your interests and/or hobbies?

How many children do you have in your home?

Question Title

15. How many children do you have in your home?

Are any foreign languages spoken in your home?

Question Title

16. Are any foreign languages spoken in your home?

Have you hosted a child, chaperone or exchange student in the past?

Question Title

17. Have you hosted a child, chaperone or exchange student in the past?

Do you have good cell phone/internet coverage in your home?

Question Title

18. Do you have good cell phone/internet coverage in your home?

Additional Comments

Question Title

19. Additional Comments

May we share your email address with the chaperon you are hosting? Some like to contact you ahead of hosting via email.

Question Title

20. May we share your email address with the chaperon you are hosting? Some like to contact you ahead of hosting via email.

Please email a picture of the outside of your home and of your family to khannon@nhfc.org. These do not need to be anything special - just some quick pictures to help our chaperons get an idea of where and with whom they are staying. This helps so much with their nervousness - especially when it is their first trip to America. Thank you!

T