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Application NA 2.2.1 – For the Parents_Candidate
2.2.1 (Candidate)
first part of 2.2 online
Step
1
of
4
- Exchange Candidate
0%
Last Name
Known As (if different)
Birthdate
Month
Day
Year
Birthplace
Nationality
Gender
Female
Male
Gender Variant/Non-Conforming
Prefer not to say
Is the child adopted?
Yes
No
Height (feet)
4
5
6
Height (inches)
1
2
3
4
5
6
7
8
9
10
11
Hidden
Height in cms
Weight (lbs)
Hidden
Weight (kg)
Parent: Please give us a short summary of candidate's personality (character, sensitivity, relationship with others, etc.)
Candidate: Activities and Personality
Please complete this section WITH the candidate
Do they practice a religion or other form of spirituality?
Do they like to read?
Do they play an instrument or sing? For how long?
What kind of outings do they enjoy (nature, museum, library, cinema, etc.)?
Member of any clubs or workshops (art, sculpture, creative writing, scouts, etc.)?
Do they play a sport with a team or club? From what age/for how long?
What sports/physical activities do they participate in on their own or with family and friends?
Are they competitive?
Do they know how to swim?
Yes
No
Swimming ability:
Weak
Average
Strong
On average, how many hours of sports per week?
Favorite out-of-school activities (games, reading, relaxing, movies, TV, cooking, video games, hanging out with friends, etc.):
Does your child have a large social group or a few close friends?
Do child's friends often come to your house? How many times per week?
Do they often go to friends' houses? How many times per week?
Has your child already been away from home (without parents)? How long?
Which of the following describe your child?
Tidy
Messy
Punctual
Procrastinator
Sensitive
Stoic
Dreamer
Realistic
Determined
Chatterbox
Active
Curious
Reserved
Creative
Extrovert
Deliberate
Spontaneous
Forgetful
Artistic
Easily Overwhelmed
Easygoing
Smiling
Select all that apply
Does your child think they have any faults? Which ones?
And how about their BEST qualities?
Choice of Country
Germany
*
Please enter a number from
0
to
100
.
Spain
*
Please enter a number from
0
to
100
.
France
*
Please enter a number from
0
to
100
.
Please explain your choice/preference - remember the more flexible you are the easier it is for us to find a match for your child.
For how long would your child like to travel?
3-6 weeks
6-9 weeks
9-12 weeks
Open, 3-12 weeks
Please give us details about any time in the next year or so that your family would NOT be able to host (already booked vacations, school commitments, camps, time-intensive sports seasons, etc.):
Your child prefers an exchange partner that is:
Boy only
Girl only
Boy or Girl
If your child is 16 or older, please indicate the date of their 18th birthday here:
MM slash DD slash YYYY
Health Questionnaire
Has the child undergone any form of surgery?
Yes
No
Comments if necessary
Have they ever had a general anesthetic?
Yes
No
Comments if necessary
Have they ever had a local anesthetic?
Yes
No
Comments if necessary
Any complications with anesthetic?
Yes
No
Comments if necessary
Are they allergic to any medication?
Yes
No
If yes, which ones?
Do they have any food allergies?
Yes
No
If yes, please list:
Have they ever had a seizure?
Yes
No
Comments if necessary
Are they asthmatic?
Yes
No
Comments if necessary
Do they have any problems with sleep?
Yes
No
Comments if necessary
Do they often have nightmares?
Yes
No
Comments if necessary
Do they sleepwalk?
Yes
No
Comments if necessary
Do they often have headaches?
Yes
No
Comments if necessary
Do they often have stomachaches?
Yes
No
Comments if necessary
Are they often constipated?
Yes
No
Comments if necessary
Do they often have diarrhea?
Yes
No
Comments if necessary
Any problems with bed-wetting?
Yes
No
Comments if necessary
Any particular skin problems?
Yes
No
Comments if necessary
Any giddiness and/or fainting, with loss of consciousness?
Yes
No
Comments if necessary
Do they suffer from any illness not already mentioned?
Yes
No
Comments if necessary
Do they take any form of medication regularly?
Yes
No
Comments if necessary
Do they wear glasses?
Yes
No
All the time, or only for certain activities (reading, watching TV)?
Do they have braces (orthodonture)?
Yes
No
Comments if necessary
Any medical reason they can't participate in sports or other athletic activity?
Yes
No
Comments if necessary
Have her periods started?
Yes
No
Comments if necessary
Blood group, if known:
unknown
O +
O -
A +
A -
B +
B -
AB +
AB -
Other remarks: allergies, headaches, eating disorder (now or in the past), travel sickness, hearing problems, dyslexia, etc.
Has your child ever consulted with a psychologist? If so, please explain.
Please describe any alternative medicine or unusual methods to treat your children when they are unwell.
Does your child or the family have any special eating habits (vegetarian, vegan, kosher, etc.)? Any food your child particularly dislikes?
Vaccination Record
Max. file size: 256 MB.
Upload a scan of your child's vaccination records.
Δ
