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Name:
Picture of you:
Class:
Tutor/Teacher:
Birthdate:
Address:
Phone:
cell phone:
FAX:
e-mail:
Father's name and occupation:
Mother's name and occupation:
Siblings (Geschwister):
What gender would you prefer to host:
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Religion:
T-Shirt Size:
Do you smoke?
Yes
No
Do any family members smoke?
Yes
No
Do they smoke inside your home?
Yes
No
Do you have any allergies?
Do you have any medical problems we should know about?
Do you have any pets?
Are there any foods you cannot eat?
What do you like to eat?
What don't you like to eat?
Do you like to try different food?
Yes
No
Would your partner have her/his own room in your home, or would they share a room?
Would you mind sharing a room with your partner in the USA?
Yes
No
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