Personal Family Questionnaire

June 11, 2011

Details of the host family:

1)   Name and age of the host mother:


2)   Her profession:


3)   Hours she stays away from home:


4)   Name of the host father:


5)   His profession:


6)   Hours he stays away from home:


7)   Do either of parents work :

a)   Yes

b)   No

8)   Home address:


9)   Contact no. of the head of the family:


10)               Email ID of the head of the family:


11)               Number of children to be taken care of:


12)               Details regarding those children:

(including their likes and dislikes, the type of foods they eat, their hobbies etc.)

__________________________________________________________________  ____________________________________________________________

13)               The language spoken at home:


14)               Do the children speak any other language? If yes, please specify.

a)   Yes

b)   No


15)               Do any of the family members have any physical or mental disability? If yes, please specify.

a)   Yes

b)   No


16)               Does your family possess any special dietary habits? If yes, please specify.

(for example: vegetarian dishes on certain days etc.)

a)   Yes

b)   No


17)               Are there any pets in the household? If yes, please specify.

a)   Yes

b)   No


Download Personal Family Questionnaire in Word Format

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