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

Top Sample Questionnaire:

Leave a Comment

Previous post:

Next post: