New Homestay
Host details
*Name
*Occupation
Employer
Part/Full Time	[Select] Part Time Full Time
*Phone(business)
Fax
Mobile
*E-mail
*Gender	Male Female
*Date of Birth
Smoke?	Yes No
Partner details
Name
Occupation
Employer
Part/Full Time	[Select] Part Time Full Time
Phone(business)
Fax
Mobile
E-mail
Gender	Male Female
Date of Birth
Smoke?	Yes No
Children living at home
Name 1
Gender 1	Male Female
Date of Birth 1
Name 2
Gender 2	Male Female
Date of Birth 2
Name 3
Gender 3	Male Female
Date of Birth 3
Others
Do you have pets?
Interests/Hobbies
Second language spoken in the house
Type of food cooked in home (e.g. vegetarian; Asian)
Special Requests (e.g. male/female; smoker/non-smoker; nationality; age; English level)
Laundry: Do you want students to do their own laundry or not?	Yes No
Guardianship: Are you prepared to act as guardian for your student if necessary?	Yes No
Payment details
*Would you like CozzyStay Homestay to pay your homestay fee directly into your bank account?	Yes No

Insurance
* Do you have public liability insurance to cover boarders?	Yes No

*Do you have contents home insurance to cover boarders?

Yes No

References
*Name 1
*Phone 1
*Name 2
*Phone 2
Observation
*Login
*Password
*Re-enter password