AVENTURO (Parent form)

AVENTURO Exchange Application Form

This form is to be filled out by the family of the child
The Child

Provide the child's legal names as they would appear on a passport
Name

First Name (include middle name/s if applicable)Last Name
Nickname (If Applicable)
Gender
Date of Birth

MonthDayYear
Country of Birth
Citizenship/ Country of Passport
Address

Street Address

Street Address Line 2

CityCounty/Province

Nearest Big TownCountry
Telephones and Emails

For telephones please provide country code, area code, number
Home Phone

Area CodePhone Number
Mother Work Phone

Area CodePhone Number
Mother Mobile

Area CodePhone Number
Father Work Phone

Area CodePhone Number
Father Mobile

Area CodePhone Number
Mother Email
Father Email
Child Email
Until what time may we phone you in the evening? (at your local time)
Home
Convenient Nearest Airports
Number of persons living in the house during the week?
Number of persons living in the house during the weekend?
Do you live in the city or countryside?
In a farm, in a village, in an estate, in a cul de sac?
In a house, a terrace, a town house, a semi-detached, a detached house or an apartment?
Number of Bedrooms?
Do you have a secondary residence?
If yes, please include address

Street Address

Street Address Line 2

CityCounty

Nearest Big TownCountry
How often do you stay at this secondary residence?
Other
Do you speak any other languages other than English to your children?

YesNo
If yes, what languages
Size of child’s bedroom in square feet or square meters
Does she/he share his/her bedroom?
Would the exchange child share a room with your child while he/she is in the family
Do you ever, for whatever reason, leave your children at home by themselves?

YesNo
If yes, explain when you leave your children at home by themselves
Do you have car(s)?
Do you have pets? Details please? Indoor/Outdoor?
Do you have musical instruments? If yes, explain
Do you have TV(s)?
How many computers/laptops/tablets are in your home?
Does your child have his/her own computer/laptop/tablet?
Does your home have unlimited WiFi? What are the rules regarding children's usage?
Child's Life
Tell us about your child's personality
What does he/she do in his/her free time?
Name the preferred school/weekend activities:
Does your child like a lot of hugs and cuddles?
Is your child vegetarian?

YesNo
Does your child have any food allergies? If yes, please elaborate.
List the food your child enjoys and likes:
List the foods your child strongly dislikes:
Is your child adopted?

YesNo
Can your child swim?

YesNo
Does your child play a musical instrument? If so, please elaborate on the type of instruments and for how long
Is faith/religion very important to your child? If so, please elaborate.
Has your child already been away from his/her parents, family and friends? (summer camps, scouts, other...)
How would you describe your child's academic ability?

Above averageAverageBelow Average
Please elaborate and try to be objective:
MOTHER or STEPMOTHER

Should the biological mother or father not be living with you, please complete the section "biological father/mother"
Married name
Maiden name
First name
Known as (nickname)
Date of Birth

MonthDayYear
Place of birth
Highest level of education
Do you speak any other languages? If so, how well?
Have you ever lived in another country? If so, for how long?
Occupation, please give precise details regarding your occupation at present as well as during the exchange if different:
Please detail working hours and arrangements for child care:
Hobbies and Interests:
Do you practice any kind of religion or faith? If yes, please explain:
Do you smoke? If yes, how many per day? Indoor/Outdoor?
Remarks about your general health?
FATHER or STEPFATHER
First Name
Last Name
Birth Date

MonthDayYear
Highest level of education
Area of speciality
Do you speak any other languages? If yes, how well?
Have you ever lived in another country? If yes, for how long? Please elaborate
Occupation, please provide precise details regarding your occupation at present and your occupation during the exchange if different.
Please detail working hours and arrangements for child care
Hobbies and Interests
Do you practice any kind of religion or faith? If so, elaborate.
Do you smoke? If yes, how many per day? Indoor/Outdoor?
Remarks about your general health:
BIOLOGICAL FATHER OR MOTHER not living in the home
First Name
Last Name
Maiden name (If applicable)
Date of Birth

MonthDayYear
Place of Birth
Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Occupation, please give precise details regarding occupation at present as well as occupation during the exchange if different
Please detail working hours and arrangements for child care
Do you agree with an exchange?
How often do you see your child?
Does the child stay overnight? When and how often?
How do you feel about welcoming your child with his exchange brother/sister?
Do you smoke? If yes, how many per day? Indoor/Outdoor?
Do you practice any kind of religion or faith?
Remarks about your general health
Siblings
1. Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Married?

YesNo
Lives at home?

YesNo
2. Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Married?

YesNo
Lives at home?

YesNo
3. Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Married?

YesNo
Lives at home?

YesNo
4. Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Married?

YesNo
Lives at home?

YesNo
5. Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Married?

YesNo
Lives at home?

YesNo
6. Full Name

First NameLast Name
Gender
Date of Birth

Area CodePhone Number
Married?

YesNo
Lives at home?

YesNo
Other
Is your child a twin?

Yes, identical twinYes, fraternal twinNo
Are you expecting a baby?

YesNo
Does the child concerned have a deceased brother or sister?

YesNo
If yes above, did the child know this brother or sister?

YesNo
If the child concerned was born after their sibling's death, does he/she know about this sibling?

YesNo
Does anyone living in the family suffer from either a mental or physical handicap or any difficulties?
Write about the relationship between the children
Is anyone taking care of the children other than you?

YesNo
If yes, please add the name and add a photo of the person

First NameLast Name
Photo of caretaker
Do you have any form of home help, either for housework or other?

YesNo
If yes above, list the ages and names of the persons, the work done, as well as the hours and days of work
Child's health
Height in inches
Weight in lbs
Is your child up to date with the obligatory vaccination?

YesNo
If no, please explain
Has your child had the chickenpox?

YesNo
If yes, when?
Is your child left handed?

YesNo
Has your child already undergone any form of surgery?

YesNo
If yes, explain
Has he/she ever had a general anesthetic?

YesNo
If yes, were there any complications?
Is the child allergic to any form of medicine?

YesNo
If yes, which ones?
For the following questions, if you answer yes to any question please explain in the space provided at the end of the questionaire
Has the child ever had an epileptic seizure?

YesNo
Does he/she have any sleeping problems?

YesNo
Does he/she often have migraines?

YesNo
Does he/she often have stomach-aches?

YesNo
Is he/she often constipated?

YesNo
Does he/she often have diarrhea?

YesNo
Does the child wet the bed?

YesNo
Any skin problems?

YesNo
Has he/she suffered from giddiness and/or fainting, with a loss of consciousness?

YesNo
Does he/she take any medication regularly?

YesNo
Does he/she wear glasses regularly?

Yes, all the timeYes, only for certain activities (reading, TV)No
Does the child have:

BracesA RetainerNone
Is there any medical reason why they may not do sports?

YesNo
Does he/she suffer from any illness not already mentioned?

YesNo
For girls: Has she started menstruating?

YesNo
If you answered yes to any of the previous questions, please explain if necessary.
Remarks on: allergies, sleep patterns, migraine, handicaps, eating disorders (now or in the past), car sickness, hearing problems, dyslexia, homeopathy, acupuncture or other practices:
Has you child ever consulted a speech therapist?

YesNo
If yes, explain
Has your child ever consulted a therapist or a psychologist?

YesNo
If yes, explain
School

Your child's school for the current school year
Principal's name
School
School Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip CodeCountry
School Phone Number

Area CodePhone Number
School Email
School Website
Type of School

PublicPrivate
The school is:

Boys onlyGirls onlyMixed
What year is your child in?
Main/class teacher:
Approximate number of pupils attending the school
Approximate number of pupils in the class
Approximate traveling distance from home to school in miles or km
How does your child usually get to school?

On footBy bicycleBy busBy Car
At what time does your child leave for school?
At what time does your child usually come back from school?
Does your child eat lunch at school?

YesNo
Does your child go to morning or after school?

YesNo
If yes, please detail times and what is done at this before/after care?
Has this school been involved in an exchange previously?
Is your child going to change school next school year?

YesNo
If yes, what is the name of the new school?
First day of school after summer holidays:
Child's home environment
If you child misbehaves or does something wrong, how do you react?
How many hour per day and per week do you allow your child to watch television?
Does your child have a television in his/her room?
How freely are your children allowed to use the computer and internet?
What is the normal bedtime during the week?
What is the normal bedtime during the weekend?
What is the normal wake up time during the week?
What is the normal wake up time during the weekend?
Which table manners are important to you?
Name your most important house rules
Are the children expected to help with household chores?
Do you supervise your children's homework? (or music practice?)
Do you allow your children to eat sweets? Often or occasionally?
Do you give pocket money/allowance? How much?
Do you have regular contact with your children's school and teachers?
Please express your observations in general about your child's relationship with...
You (parents):
Siblings:
Grandparents:
Your extended family:
Your (parents) friends:
Your other children's friends:
His/her own friends and school mates:
How often do you entertain family/friends at your house?
What do you (parents) do with your children in your free time and on weekends?
Please write specific instances which relate to your family life (deaths, divorce, second marriage, adoption, ect.)
What special dates are celebrated in your family?
The exchange family
What qualities are you looking for in an exchange family?
Your family and aventuro
How did you hear about Aventuro? If you heard from a family who has done an exchange, please name them.
Previous exchanges
Has your family already taken part in one or more exchanges?

YesNo
Is yes, please give us the name, postal, email addresses, and phone number of your foreign families with dates of previous exchange
References

Please provide us with two families (if possible a family with children of similar age to your child) who know your child and your family well but who are not related to you. We will contact these families for a reference.
First Family
Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Occupation
Second family
Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Occupation
Photos

Please attach photographs of your house (inside and out) and all family members. This is very important for us to find the perfect match for your family exchange. One family photo, one of the child her their friends and some more you feel may show us their personality. The photos of your home are to show the international child where they will be living, the sitting room, kitchen, their bedroom and the view from the house etc. It helps for them to visualise where they will be living, and you will also receive the same from the exchange family! Please ensure photos are not too big or form will not submit!
Photo 1
Photo 2
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7
Photo 8
Photo 9
Photo 10
Our Bank Details
There is a €100.00 non-refundable administration fee to be paid directly to our company bank account. Forms will only be processed when the aforementioned fee has been paid. Please list your full child's name as the reference so we can track the payment.

( If your child has been awarded this exchange or won this exchange as part of a promotional competition please contact us so we will wave this fee)

Bank Name: AIB Upper Salthill, Galway

Bank Account Name: Ms Sinead Muldoon

T/A The Irish Education Academy

Bank Account Number: 29013-057

Sort Code: 93-74-01

IBAN: IE35AIBK93740129013057
Alternatively, you may pay the deposit via PayPal below by checking the deposit box
My Products
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Deposit€100.00

Total €0.00
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Thank you,

Sinéad Muldoon
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AVENTURO Exchange Application Form

The Child

Telephones and Emails

Home

Other

Child's Life

MOTHER or STEPMOTHER

FATHER or STEPFATHER

BIOLOGICAL FATHER OR MOTHER not living in the home

Siblings

Other

Child's health

School

Child's home environment

The exchange family

Your family and aventuro

Previous exchanges

References

Photos

Our Bank Details