Homestay Application Form 1. About you First Name Last Name Gender Select Male Female Home Address Country Post Code Telephone Mobile Phone Email 2. About your home If you have any children or adults living in your home, please list their names and dates of birth: Name Date of Birth Family Religion Does anyone in the family smoke? (Y/N) If you have any pets at home, please list how many and what type of pets you have: Type of Pet How Many Type of Pet How Many Type of Pet How Many Type of Pet How Many Please tell us about your family’s hobbies and interests Type of Property Select Detached Semi Detached Terraced Bungalow Maisonette Town House Flat How many rooms do you have available for students: Select 1 2 3 4 Please tell us about the rooms including whether they are single, double or twin rooms and have access to a shared, private or ensuite bathroom: All rooms must conform to the requirements set out in the Beet Language Centre Terms and Conditions. The room must be in a proper state of cleanliness and repair and have adequate heating and natural lighting. The room should be furnished with a standard-size bed/mattress (temporary beds such as sofa beds, camp beds or futons are not acceptable). Adequate hanging and drawer space for clothes and personal belongings should be provided. A table or desk and a chair for study purposes should be included in the student room where possible. When this is not the case a suitable room should be made available where the student can study quietly. Your gas appliances, including your boiler, oven, hob and gas fires, should be serviced on an annual basis by a Gas Safe Registered Engineer. Under Gas Safety (Installation and Use) Regulations 1994 you must be in possession of a current Gas Safety Certificate. Do you have a current Gas Safety Certificate? Select Yes No 3. What are you looking for from a student? Will you allow students to smoke outside? Select Yes No Dietary options you can cater for: All No Pork Halal Gluten-Free Vegan Diabetic Low Fat Nut Allergy Do you offer WiFi? Select Yes No 4.Childrens Act 1989 (Part 9) Declaration Regarding Suitability to Foster Children Privately Have you or any members of your household ever: Been convicted of any offences involving a child? Had a child removed from your care by the order of any court? Had registration under Part 9 of the Children Act 1989 refused or cancelled (childminding)? Had a prohibition from private fostering imposed on you at any time? Been disqualified from acting as a foster parent? If the answer to any of these is yes, please supply the dates and details: Section 70 (1) (a) of the Children Act 1989 provides that a person who makes any statement in this notice or information which he knows to be false or misleading, shall be guilty of an offence and liable on summary conviction to fine not exceeding level 5. I, and all the adult members of our household, agree to BEET Language Centre arranging an enhanced Criminal Records Bureau check for previous convictions. I have read and accept the Beet Homestay Terms and Conditions for the provision of homestay accommodation. How did you find out about BEET?
