HOST FAMILY INFORMATION
Gate way to th e N H L
Dort Federal Credit Union Event Center 3501 Lapeer Road, Flint, MI 48503 P: (810) 744-0580 F: (810) 744-2906
HOST FAMILY INFORMATION Names: _____________________________________________________________________________________ Address: ____________________________________________________________________________________ City: ____________________________________ State: ______________________ Zip: __________________ Other family members in the home (names & ages of children) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Please list all adults 18 years of age or older, who reside in your home. Background checks will be necessary for all. ____________________________________________________________________________________________ ____________________________________________________________________________________________ School District: ________________________________________________________________________________ (Adult Female) Email Address ________________________________________________________________________________ Contact Numbers ______________________________________________________________________________ Occupation __________________________________________________________________________________ (Adult Male) Email Address ________________________________________________________________________________ Contact Numbers ______________________________________________________________________________ Occupation __________________________________________________________________________________ Previous experience as a Host family? _____________________________________________________________ Please list any Flint Firebirds staff you know: _______________________________________________________ ____________________________________________________________________________________________ Any smokers in your household?
YES
NO
Regularity of alcohol consumption in your home? ___________________________________________________
Family Interests & Activities: ____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Any pets in your home? What type: _______________________________________________________________ ____________________________________________________________________________________________
Religious Affiliation? _________________________________ Do you attend church regularly? ______________
FOOD How often do you expect to be able to provide a home-cooked evening meal? REGULARLY
OCCASIONALLY
RARELY
NEVER
How often do you expect to provide “take-out” evening meals? REGULARLY
OCCASIONALLY
RARELY
NEVER
How often do you expect the player to prepare his dinner from food you have left for him (i.e. leftovers)? REGULARLY
OCCASIONALLY
RARELY
NEVER
How would breakfast and school lunches be handled in your home? _____________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What are your normal family meal hours: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What are your favorite meals? ____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Does anyone in your family follow a vegetarian or gluten free diet?_______________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
LAUNDRY How often do you expect to be able to help the player by doing his laundry? REGULARLY
OCCASIONALLY
RARELY
NEVER
TECHNOLOGY Do you have an established guideline for TV? _______________________________________________________ Do you allow televisions in bedrooms? ____________________________________________________________ Do you have a cell phone or time limits on phone/computer usage in your home? ____________________________________________________________________________________________ ____________________________________________________________________________________________
EXPECTATIONS AND COMMENTS What expectations do you have of the player and his family with regard to how to make this a positive experience for all concerned? _____________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Please share any additional information about your family that you feel would be helpful in making a good match for you and your family: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
How did you find out about our host family opportunity? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Flint Firebirds Hockey expects host families as well as players to abide by ALL the rules set forth in the “Blue Book” – a copy of which will be provided to you. Please read over the list below of basic rules pertaining to all host families.
HOST FAMILIES RULES 1. Host families should NEVER call in a player sick to school – All school absences must be cleared by Flint Firebird coaching staff. 2. Host families should never refer players to their own physicians without approval of the Firebird medical staff. 3. Please report any curfew violations to the coach as soon as they occur. 4. Players are not allowed to leave the Flint/Grand Blanc area without approval of coaches. 5. If there is a gathering of more than 4 players in a home, a coach needs to be notified. If this happens at your home, please call or email a coach to let them know-preferably ahead of time. 6. There are no girls allowed in the host family home if the host family is not at home. 7. If in doubt about anything that is happening with your player – please call your housing contact and/or Flint Firebirds Hockey staff member and ask.
Signature: __________________________________________________________________________________ Date: _______________________________________________________________________________________
Dort Federal Credit Union Event Center 3501 Lapeer Road, Flint, MI 48503 P: (810) 744-0580 F: (810) 744-2906
HOST FAMILY INFORMATION Names: _____________________________________________________________________________________ Address: ____________________________________________________________________________________ City: ____________________________________ State: ______________________ Zip: __________________ Other family members in the home (names & ages of children) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Please list all adults 18 years of age or older, who reside in your home. Background checks will be necessary for all. ____________________________________________________________________________________________ ____________________________________________________________________________________________ School District: ________________________________________________________________________________ (Adult Female) Email Address ________________________________________________________________________________ Contact Numbers ______________________________________________________________________________ Occupation __________________________________________________________________________________ (Adult Male) Email Address ________________________________________________________________________________ Contact Numbers ______________________________________________________________________________ Occupation __________________________________________________________________________________ Previous experience as a Host family? _____________________________________________________________ Please list any Flint Firebirds staff you know: _______________________________________________________ ____________________________________________________________________________________________ Any smokers in your household?
YES
NO
Regularity of alcohol consumption in your home? ___________________________________________________
Family Interests & Activities: ____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Any pets in your home? What type: _______________________________________________________________ ____________________________________________________________________________________________
Religious Affiliation? _________________________________ Do you attend church regularly? ______________
FOOD How often do you expect to be able to provide a home-cooked evening meal? REGULARLY
OCCASIONALLY
RARELY
NEVER
How often do you expect to provide “take-out” evening meals? REGULARLY
OCCASIONALLY
RARELY
NEVER
How often do you expect the player to prepare his dinner from food you have left for him (i.e. leftovers)? REGULARLY
OCCASIONALLY
RARELY
NEVER
How would breakfast and school lunches be handled in your home? _____________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What are your normal family meal hours: __________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What are your favorite meals? ____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Does anyone in your family follow a vegetarian or gluten free diet?_______________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
LAUNDRY How often do you expect to be able to help the player by doing his laundry? REGULARLY
OCCASIONALLY
RARELY
NEVER
TECHNOLOGY Do you have an established guideline for TV? _______________________________________________________ Do you allow televisions in bedrooms? ____________________________________________________________ Do you have a cell phone or time limits on phone/computer usage in your home? ____________________________________________________________________________________________ ____________________________________________________________________________________________
EXPECTATIONS AND COMMENTS What expectations do you have of the player and his family with regard to how to make this a positive experience for all concerned? _____________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Please share any additional information about your family that you feel would be helpful in making a good match for you and your family: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
How did you find out about our host family opportunity? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
Flint Firebirds Hockey expects host families as well as players to abide by ALL the rules set forth in the “Blue Book” – a copy of which will be provided to you. Please read over the list below of basic rules pertaining to all host families.
HOST FAMILIES RULES 1. Host families should NEVER call in a player sick to school – All school absences must be cleared by Flint Firebird coaching staff. 2. Host families should never refer players to their own physicians without approval of the Firebird medical staff. 3. Please report any curfew violations to the coach as soon as they occur. 4. Players are not allowed to leave the Flint/Grand Blanc area without approval of coaches. 5. If there is a gathering of more than 4 players in a home, a coach needs to be notified. If this happens at your home, please call or email a coach to let them know-preferably ahead of time. 6. There are no girls allowed in the host family home if the host family is not at home. 7. If in doubt about anything that is happening with your player – please call your housing contact and/or Flint Firebirds Hockey staff member and ask.
Signature: __________________________________________________________________________________ Date: _______________________________________________________________________________________
