Become a Host - Apply Now - College Guardians

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About your family

1.

Surname*

First names*

Home Address

Date of birth

Gender

Male

Female

Valid Driving Licence

Yes

Nationality

Religion

Occupation

Daytime phone number

Evening phone number

Mobile phone number

Email address

2.

Surname of spouse/partner

First names

Date of birth

Gender

Male

Female

Valid Driving Licence

Yes

Nationality

Religion

Occupation

Day time phone number

Daytime phone number

Evening phone number

Mobile phone number

Email address

About your family

3. Other people living in your home:

Please provide details of everyone else living in your home.

Full name

Gender (M/F)

Relationship to you

Date of birth (dd/mm/yyyy)

4. Please give details of the family’s interests and hobbies:

5. Please give details of you and your partner/spouses(s) work (paid and unpaid) and usual working hours:

Hosting

6. How many students are you prepared to host at any one time?

7. What age student(s) are you prepared to host?

(please tick all that apply)

5-7 years

7-10 years

10-13 years

13-16 years

16-18 years

18+

8. Are you happy to host a student of either gender?

9. Hosting options preferred?

10. Please indicate the time(s) of year when you may generally not be available:

Please provide details of previous hosting experience, if any (including dates), and why you and your family would like to host:

About your home

12. Please provide a brief description of your family home, including how many rooms, and how many bedrooms your home has:

13.

Details of the bedroom(s) available for hosting student(s) - please tick all that apply:

Bedroom One

Separate bedroom

Ensuite

Single bed

Double bed

Desk and chair

Bedroom Two

Separate bedroom

Ensuite

Single bed

Double bed

Desk and chair

Bedroom Three

Separate bedroom

Ensuite

Single bed

Double bed

Desk and chair

14.

Details of the property: Please indicate whether or not the property has the following:

Front Garden

Yes

Back Garden

Yes

Broadband Internet Connection

Yes

15.

Are there any smokers in the home?

Yes

Is smoking allowed in the home?

Yes

16.

Are there any family pets in the home?

Has any family pet caused anyone a personal injury or been the subject of a complaint?

17. Names of other temporary, permanent or international students staying at the property

18.

Car Insurance: Does your car insurance cover you to drive students?

Yes

Car Insurance: Does your car insurance cover you to drive students?

Yes

Does your household insurance policy cover you to host students on an occasional basis?

Yes

Does your home have smoke alarms?

Yes

Does your home have carbon monoxide monitors?

Yes

Do you have a Gas Safety Certificate for your home?

Yes

Do you have a First Aid Kit in your home?

Yes

About your home

Has any full-time resident in the household ever:

Been convicted of any offence against a child?

Yes

Been entered on the child protection register or been the subject of a child protection plan?

Yes

Had a child removed from your care by order of a court?

Yes

Been denied access to or made subject of an injunction regarding your own or other children?

Yes

Been disqualified from activity as a foster parent?

Yes

Been refused registration under the Children Act 1989 e.g. as a child minder?

Yes

Been on the list of individuals barred from working with children or otherwise disqualified to work with children, administered by the DBS or subject to sanctions imposed by any regularity body?

Yes

Been convicted of a criminal offence or have a court case pending?

Yes

Had family court, civil court or criminal justice system incidents / appearances?

Yes

Been subject to a ‘sex offender order’, civil finding or injunctions (relevant to any family court matter, domestic situation child or children)?

Yes

Been subject to an emergency protection order?

Yes

This position is exempt from the Rehabilitation of Offenders Act 1974 and therefore all convictions, cautions, written warnings, bind overs, including those regarded as ‘spent’ must be declared. If you have answered ‘YES’ to any of the questions above, please supply further details along with the relevant dates on a separate form marked Private and Confidential for the attention of the Director of Guardianship Services.

Section 70a of the Children Act 1989 states that a person who gives information which he/she knows to be false/misleading or makes a statement in this notice will be guilty of an offence and liable on summary conviction to a fine.

Please note: having a criminal record nay not necessarily stop you from working with our company; this will depend upon the nature of the offence.

DECLARATION AND SIGNATURE

Data Protection: By signing this form, you are confirming that College Guardians may obtain, process and hold personal information about you and your family, including sensitive information (such as details of any convictions), and that you consent to this for the purposes of assessment.

First Person

First Signature

Full name

Second Person

Second Signature

Full name

Please provide details of the names of two character referees one of whom should be a professional person and must have known you for at least two years:

Reference One

Reference one signature

Address

Name

Telephone Number

Email Address

Reference Two

Reference Two Signature

Name

Telephone Number

Email Address

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Host Family Registration Form

About your family

1.

2.

About your family

Hosting

About your home

13.

14.

15.

16.

18.

About your home

Has any full-time resident in the household ever:

DECLARATION AND SIGNATURE

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