Locks Hill, Portslade, Brighton, BN41 2LA
Email: [email protected] Tel: 01273 414973
Surname:
Address:
Host/Hostess Personal Details (main carer)
First name:
Tel (home):
Date of birth:
Occupation:
/
/
Tel (mobile):
Email address:
Interests:
Spouse/Partner Personal Details
Full name:
Date of birth:
Occupation:
/
/
Interests:
Children at home
First name:
First name:
First name:
Any other person living with you
First name:
Date of Birth:
Date of Birth:
Date of Birth:
/
/
/
/
/
/
Date of Birth:
/
/
Please confirm the number of rooms you have available for our use:
Sole use of bathroom?
Singles:
Doubles/Twins (circle):
Yes
Will you accept…?
Female students: Yes
Nationality and/or gender preferences?
No
Male students: Yes No
Under 18s? (DBS info below)
No
Yes
No
Will you cater for special diets?
Yes
No
Which diets?
Does anyone in the family smoke?
Yes
No
Will you accept smokers?
Yes No
Outside only
Do you have pets? Yes No
Details:
Yes No
Do you have wireless internet access for students?
Are you registered with any other schools? Yes No
Which ones?
If accommodating students under 18yrs it is necessary to run a DBS check on the main carer.
Please tick to confirm that the following has been verified by LEC at time of visit *:
Identity and date of birth (passport)
Proof of address (utility bill within last three months or current driver’s licence)
Current email address
*Inform host s/he will soon receive an email from us requesting more information. Host must reply to this
email as soon as possible. If not done so within three months, LEC must reverify the above.