Home Host Questionnaire - Bathurst Region Tourism

Japanese Home Host Questionnaire

Thank you for expressing your interest in participating in the Japanese Home Stay Program. Please fill out the form below. The collection information provided by this form will be used only in the Japanese Home Hosting Program organised by the Bathurst Visitor Information Centre. For the purposes of allocating appropriate students to host families, and in creating host family profiles that will be provided to students to familiarise themselves with their host families.

Name*
First Last
Preferred Email Address*
Primary Contact Number*
Secondary Contact Number
Home Address*
What is your date of Birth*
In order to verify working with children certificates we require your date of birth.
Day
Month
Year
What is your date of Birth*
In order to verify working with children certificates we require the date of birth of every adult with WWCC
Day
Month
Year
What is your date of Birth*
In order to verify working with children certificates we require the date of birth of every adult with WWCC
Day
Month
Year
Working With Children Identifier number*
Please enter in the working with children identification number for each legal adult in your household (including spouses, children who are 18+ & relatives or visitors who will be living in your home during the student's stay). Please also include their birthday for verification purposes. It is a requirement of the homestay program that each adult 18+ living in the household possesses a working with children check, a volunteer check is acceptable. If you do not have a working with children number you can apply for a volunteer working with children check and provide the application number.
Do you have any pets?
If yes to the Question above. What animal/s and are they kept inside or outside?
This helps us align students with allergies to suitable host families.
How many students do you intend to host?*
Please indicate how many students you would like to host.
Do you have a gender preference for the students you host?
If your preffered student gender is not available, would you be happy to host students of the opposite gender?
Please Upload one photo of each bed you intend to provide to your student/s. If unable to upload your photos please email them to rebecca.stapleton@bathurst.nsw.gov.au
As a part of the Home Stay Program requirements. Students require their own bed in either a single or twin share bedroom (note that sharing with family members is not accepted). To ensure that we are sending students to homes that meet this requirement please upload a photo of each bed you intend to provide to your student/s. If you are unable to upload a photo/s please contact Rebecca (rebecca.stapleton@bathurst.nsw.gov.au) at the Bathurst Visitor Information Centre to organise an alternative.
Drop files here or

Max. file size: 128 MB, Max. files: 8.
Do you have children of your own? If so what are their names and age?
This helps us allocate students to families.
Does anyone in your household have first aid training?
This is not a requirement of the home hosting program but can assist is allocating students with medical conditions such as diabetes or severe allergies. Where in rare cases medical attention may be needed.
Are there any other comments or concerns that you wish to inform us of?
Data Collection Consent*
The information on this form is being collected to allow Council to process your application and/or carry out its statutory obligations. All information collected will be held by Council and will only be used for the purpose for which it was collected. An individual may view their personal information and may correct any errors.
I understand and I agree to the privacy policy.