Homestay Application on     

Submitted by i.e. applicant name, parent, organization, or other:

Subject : Student Homestay Application Visitor Homestay Application for host family application, please click here

Destination / City or Town: Victoria, BC, Canada Vancouver, BC, Canada Whistler, BC, Canada Toronto, ON, Canada Other, specify next Other

*Student/Visitor Information:

First Name: Last Name: 

Home Address:

City/Town:   Province/State:

Country: Postal/Zip Code:

*Email Address: Phone:

Gender: Male:  Female:   Nationality Age:

Date of Birth (day-month-year): Passport No.

If you there are traveling with a family member or companion,

please specify here

Parent(s) Information (If available)

Parent Name(s) :

Street Address:

City/Town: Province/State:

Country: Postal/Zip Code:

e-mail: Phone:

Important: Please recheck your email and phone number for any typo.

*Emergency Contact, if different than parent(s)

Name: Phone:

Relationship: e-mail:

Homestay Requirements

*Homestay Dates (dd-mm-yyyy): From:   To:

Level of accommodation required: Select Level... Standard Semi-Deluxe Deluxe (with private bath) Deluxe Studio Suite (with kitchen)

Without Meals:   With meals:  Choose meal plan... with three meals with two meals, breakfast and dinner with Breakfast only without meals

Do you accept the homestay program rates?  Yes    No

Knowledge of English language:   Beginner Intermediate Advanced

Hobbies & Career Goals:

What is the purpose of your stay in Vancouver? study, but not sure where! study English study English (not sure yet!) studying in vocational schools studying in high school studying in college studying in University study and work holidays and touring working holidays homestay and culture leisure landing (landed immigrant) internship business training business visit business project educational research athlatic training sports tournaments Other...specify in comments

*Which School, College, University, or Internship

will you be attending in Vancouver?  (nearby homestay location, if available)

School Name:

School Address: 

School start date: (day-month-year)

Do you have a Student Visa?  Visitor Visa?  Working Holiday Visa

Resident Visa?  Canadian Citizen?  none, so far?

Since a hospital bed costs about $5,000 a night,

Do you have Medical Insurance?                Yes     No 

If no, will you purchase insurance?             Yes     No 

Please note that insurance cost is about $2 a day, but very valuable

If you will purchase, would like more info!   Yes     No 

Do you smoke?                                         Yes     No

IF YES, are you willing to smoke outside?    Yes     No

Please note that smoking is not allowed anywhere inside buildings.

Do you drink Alcohol?                                Yes     No

Is a home with a pet acceptable?                Yes     No

If you selected no to pets, which house pet(s)? choose rejected pet... large dog or dogs small dogs and puppies all dogs cats birds all pets other, specify in comments

Do you have allergies?                               Yes      No

If yes, caused by:     

Do you have any physical disabilities?         Yes      No

If yes, please explain:

Do you require special medical treatment?  Yes       No

If yes, please explain:

Do you need a special diet?                        Yes      No

If yes, please explain:

Additional comments, questions, concerns

How did you hear about us? If you found us on the Internet,

which search engine did you use and what did you type?    

Flight information (If possible): 

Do you require airport pick up service?  $75.00    

Yes: (Recommended)     No:

Arrival date: (day-month-year)     Airport Name:

Airline: Flight# Arrival time: 

Do you require pick up from Ferry Terminal in Sidney to host family in Victoria? $75.00   

Yes: (Recommended)     No:

Do you accept our placement fee?                       Yes      No

Do you agree to Student or Visitor Guidelines?  Yes      No

Do you accept our disclaimer?                             Yes      No

If you are sharing the room with a friend or a relative, please fill another application for a second person. By submitting this application you acknowledge that you true and binding, and that you will allow a couple of weeks for our research and that you will check your email regularly for expected family profile or contact us to follow up. Please check the next page, after clicking submit, for further instructions.