REGISTRATION FORM FOR CANADIAN FAMILY



REGISTRATION FORM FOR CANADIAN FAMILY

CULTURAL EXCHANGE PROGRAM

Canada-Mexico Cultural Exchange Centre

509 Commissioners Rd. W Suite 51

London, ON N6J1Y5

email: mdeantunano@

Website:

DATE: __________________________________

NAME OF THE CANADIAN PARTICIPANT: _______________________________________________

COMPLETE MAILING ADDRESS: ____________________________________________________________

____________________________________________________________

TELEPHONE: OFFICE_____________ HOME____________

Best time to call:_________________________________

FAX: _______________________________

E-MAIL: ______________________________

DESCRIPTION OF THE FAMILY:

Number of members, names, dates of birth, occupations

How would you describe your family in 2 sentences?

Describe your child(ren)’s personality: what do they like and dislike?

Are there other adults outside the immediate family who will be in constant contact with the children’s home? (e.g. grandparents)? Please explain.

Pets: Specify pet policy in your home:

Are there any smokers in the house? ____ YES _____NO

Do they smoke inside the house?____ YES _____NO

Do you want a _____non-smoker _____ doesn’t matter

Choose the ones that better describe your household (choose as many as needed). Be as honest as possible. These questions help us find you the best match possible.

__ Busy ___ Very busy _____ Beyond busy ____ Calm ____ Tidy ____Clean freaks ____ Lived _____ Practicality first, looks after ( e.g. living room is a play area with visible toys everywhere) ____ Loud ____ Quiet

_____ Temperamental family

_____ When there is a problem we tend to withdraw first then when calmed we discuss

_____ Money is a stressor in the household

_____ Work is a stressor in the household

_____ Happy go lucky

_____ Stress in the house from one to ten ( ten the highest) _____ One or more members in the household are noise sensitive

_____ Serious

_____ Very responsible

_____ Structured

_____ Planners ( e.g. Mondays cleaning day from 8-2 meal from 2-3 rest 3-4 , hard to change previously planned routine).

_____ Do as we please, little planning.

_____ One or more members in the family are smell sensitive (perfumes etc.)

_____ Chores in the household are fairly divided among all members one to ten (ten being the fairest).

_____ Noisy

_____ Kids can play in all areas of the house

_____ Kids have some restrictions in some areas of the house e.g. eating in the living room.

_____ Kids rule

_____ Both parents and kids rule

_____ Only parents rule

_____ Laid back

_____ Fun

Any others you can think of:

Describe a typical day in your home, include bedtime routine and times:

Does your family eat meals together?

Which ones?

How often?

Describe the kinds of food your family eats, specify any kinds of food you do not eat or allow in your home (e.g. pork):

Would you be able to provide the candidate with fresh wholesome food consistently?

Any suggestions to the candidate so the family can make sure they are providing food the candidate likes?

Religion:

DESCRIPTION OF THE HOUSE AND PLACE FOR THE MEXICAN CANDIDATE:

Kind of room and location within the house:

Shared washroom _____YES _____NO

If yes, specify with whom:

Describe washroom (e.g. tub, shower only, no shower, etc.):

Location of the house in relation to downtown Toronto:

How long will it take to get downtown via public transit? Any bus transfers, etc.? Cost?

DESCRIPTION OF WHAT IS REQUIRED:

REASONS FOR WANTING TO PARTICIPATE IN THE PROGRAM:

HIGHLIGHTS:

Include 2 references ( phone number and position ). These have to be non family members or friends. A former Nanny, a colleague or boss at work would be good references.

Please attach a picture of your family and home.

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