Kiwi HomeStay

Your Information

Family Name:

First Name:

Nickname / English name:

Gender:
Female Male

Date of Birth:

Nationality:

English Language Ability:
Poor Fair Good Excellent

Home Address

Address 1:

Address 2 (optional):

City:

Area Code (optional):

Country:

Contact Information

Email Address:

Home Phone:

Your trip to New Zealand

School / Institution in New Zealand:

Date of arrival at your Homestay:

Length of stay in Homestay:

Flight Number:

Flight Arrival Date:

Flight Arrival Time:

Do you require pickup:
Yes No

Address in New Zealand if already here:

Family Information

Personal Information

Would you prefer to stay with a family:
With young children
With older children
Young, with no children
Older, children left home

Have you ever lived or travelled outside your country:
Yes No

If yes, please explain:

What languages can you speak:

What is your religion:

Do you drink alcohol with your family/friends:
Never Sometimes Often

Do you smoke:
Yes No

Could you live with a family who smoke:
Yes No

Do you like animals:
Yes No Don't Mind

Do you have any allergies:

What foods don't you eat:

What do you like to do in your spare time:

By submitting this form, you agree to the conditions for homestay accommodation for International Students.