Host Family Questionnaire Host Family Name * Address * City/Zip * Home Phone * Cell Phone List children's names, ages, and any hobbies/interests * Emergency contact name * Emergency contact phone * Emergency contact Address * Homeowner's Insurance Co. * Agent's Name and Number Amount of liability homeowner coverage in force? Husband's current employer * Husband employer address * How long with employer * Husband position held * Husband work phone * Husband cell phone * Wife's current employer * Wife employer phone * Wife employer address * Wife how long with employer * Wife position held Wife cell phone * In the last 3 years have you been or are you currently affiliated with any youth, high school, or collegiate sports organization or team? * If yes, what capacity? Have you ever been or are you currently affiliated with, employed by, or maintain a consulting relationship with any company that presents itself as a sports agency? * If yes, please provide complete details of this relationship. Have you or a member of your household ever pleaded guilty or no contest, or been convicted of a crime? * If yes, please provide date and details. Does anyone in your family smoke? * If yes, whom? Do you have pets? * If yes, what kind and how many? Please provide contact information for three (3) non-family references: *
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