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Vancouver Homestay Agency

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Vancouver Homestay

Brochure (English)

 

 

Homestay Application: if you are looking for host application, please click here

Please fill-out all parts of this application in order save time and allow VHA to help you. We require all information to be completed to the best of your knowledge.

NOTE: Incomplete application will not be considered. After submitting this application, you will be prompted to pay a deposit via secure Paypal. If you have any challenges completing this form or if you have any questions, please call us at +1 778 280-3037

Homestay Destination*

Application Type

    
Submitted by  

Submitter Name

  
Destination (Country)  

Other Country

  
City/Town*  

Other City/Town

  
Personal Information*
First Name*   Last Name*  
Male Female

 
Citizenship*   Age*  
Birth Date* Passport/ID No.*  
Type of Visa    
Applicant Address & Contact Details*
Home Address*  
City/Town*   Province/State*  
Country*   Postal/Zip Code  
Email Address*    
Tel. Country Code*   Area Code*  
Home Phone*   Cellular/Mobile  
Parent or Guardian Contact*
Parent Name  
Email Address  
Tel. Country Code   Area Code  
Home Phone   Cellular/Mobile  
Emergency Contact*
Emergency Contact:*  
Email Address*:  
Tel. Country Code*   Area Code*  
Home Phone*   Cellular/Mobile  
Applicant Requests*
Homestay starts*
Homestay ends*
Traveling Companions  
Level of Homestay*    
Meals Plan*    
Do you smoke?

Yes

 No    
Smoking outside?

Yes

 No  
Do you drink alcohol?  
Home with pet    
Any allergies?

Yes

No

  
If yes, caused by  
 
Any Health Condition?

Yes

No

  
If yes, please explain:  
 
Any Special Diet?

Yes

No

  
If yes, please explain  
 
Any Special Request  
 
 
 
Emergency Healthcare Insurance*

 Healthcare insurance coverage is obligatory, if you did not purchase your insurance.
Healthcare Insurance*  
Hobbies & Career Information*
Spoken English:  
Will you join a school?

 

 Yes

No

   
If no, purpose of visit    
If yes, school Name  
School Address  
 
School start date
Hobbies  
 
Career Goals  
 
Travel Details (if available)
Arrival Date Airport name/code  
Arrival Time Airline & Flight No.  
Require Airport Pickup

Yes

 No

(Yes, recommended)
Agreements*
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.

 
 

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