WISCONSIN MUSTANGS
2008-2009 HOUSING FAMILY APPLICATION
Name:
Address:
City:
State:
Zip Code:
Host Father Occupation:
Work Phone:
Cell Phone:
Host Mother Occupation:
Work Phone:
Cell Phone:
Conact Email Address:
Do you have any children?
Select One
Yes
No
If yes, please provide info below.
Name:
Age:
Gender:
Gender
Male
Female
Name:
Age:
Gender:
Gender
Male
Female
Name:
Age:
Gender:
Gender
Male
Female
Name:
Age:
Gender:
Gender
Male
Female
Do you have any Pets?
Select One
Yes
No
If yes, please provide info below.
Type:
Select One
Dog(s)
Cat(s)
How Many:
Select One
1
2
3
4
Inside/Outside:
Select One
Inside
Outside
Both
Type:
Select One
Dog(s)
Cat(s)
How Many:
Select One
1
2
3
4
Inside/Outside:
Select One
Inside
Outside
Both
Why are you interested in becoming a Host Family?
Does anyone in the house smoke?
Select One
Yes
No
If yes, where:
Select One
Inside
Outside
Garage
Will you notify the housing coordinator if there are any concerns with your player or if the player is involved with drinking, drugs or violating curfew:
Select One
Yes
No
What is the proximity of your home from the Northwest Sports Complex:
What does your family enjoy to do (Hobbies)?
How many players are you interested in hosting:
One
Two
Three
Four
Five
Six
Would you be supportive if the player living with you was traded:
Select One
Yes
No
, if so would you take another player:
Select One
Yes
No
USA Hockey guidelines stipulate background checks to be conducted on all host families. Would you agree to a background check on you and your family members:
Select One
Yes
No
Thank you for your interest in becoming a host family
for the 2008-2009 Hockey Season
For more information, please contact:
Doralee Roberts @ 715-635-8207