Host Family Application

Other Host Family Information
Other Host Family Information
Is English your family's primary language?*
- Yes
- No
What other languages do you speak?
What are favorite hobbies/activities of your family?
With which church are you affiliated? Please include pastor's name.
Does anyone in your household smoke?*
- Yes
- No
Please list medical conditions any member of your household has that Grace Academy should be made aware of.
References
Please list three references. References may NOT be family members.
Name*
Relationship to Applicants*
Years Known*
Phone Number*
Relationship to Applicants*
Years Known*
Phone Number*
Relationship to Applicants*
Years Known*
Phone Number*
Host Family Applicant Agreement
I hereby affirm that the information provided above is accurate and true to the best of my knowledge. This information provided is strictly for homestay purposes. All personal information will remain confidential.

I agree to hold Grace Academy and the host family coordinator harmless for any damages, losses or injuries incurred during the international student’s homestay period.

I understand that my digital signature below is the legal equivalent of my manual signature on this agreement.
Host Father Digital Signature*
Date*
MM slash DD slash YYYY
Host Mother Digital Signature*
Date*
MM slash DD slash YYYY

Student Information