Homestay Host Family Application Form

Please complete as best as possible and then press the SUBMIT button to send the form to Contact Canada.

 We currently require more family registration in the following cities...

  • Victoria, BC 
  • Vancouver, BC
  • Burnaby(easier access to downtown Vancouver) , BC
  • North Vancouver (easier access to downtown Vancouver) , BC 

First Name:  
Last Name:   
Street Address:
 
 
City:
 
  Postal Code
Telephone:   Home:    Cel:  Work: 
Fax:   Home:    Work: 
E-mail:  
Members of Household (including yourself)
 
Name
(First / Last)
Relationship Occupation Birth Date
(MM/DD/YYYY)
Place of employment:  
Parents' first language and other languages :  
Family's hobbies and interests:  
To what degree would the student participate in your family's activities?  

 

Please give a general description of your meal routine (breakfast, lunch, dinner). How much help do you expect in preparation and clean-up?

 

 

What are your family's rules about cigarette smoking and alcohol drinking? Would you be willing to take a smoker if he/she went outside to smoke?

 

 

What pets do you have?

 

 

Please describe the quickest Public Transportation route(Bus or Subway) to the downtown area from your house (include bus #(s) & approx. length of time).

 
Please indicate the type of your home:  
How many students can you accommodate?   Private   Shared
Please state preference:   Male  Female  No Preference
Acceptable Student Age:    14-16  17-19  20-24  Older  No preference

Please indicate the most convenient and most inconvenient time of year:

 
Please indicate how long you would be willing to host a student (You may check more than 1 box):   less than 1 week 1-3 weeks 1-3 months
3-6 months more than 6 months
Please indicate the size of your room(s):   Room 1
Room 2
Room 3
Do you have an Internet access at home ?   Yes No

Would you accept the idea of international visitors using YOUR computer for Internet access ?

  Yes No
Would you accept the idea of international visitors using their own computer for Internet access through your home phone line ?   Yes No

Have you hosted any foreign students before? How many? Please comment.

 
Please list any homestay programs that you have hosted for in the past or currently host for :   1.
2.
3.
Please give your reason for wanting to host an overseas student.
 
 
Please provide extra information that you think is significant on Homestay:  
Where did you hear about Contact Canada?  

Please give two references (including full names, telephone numbers, and relationships)

Name Relationship Telephone

 

I AGREE CONTACT CANADA OR ITS AGENTS DO NOT ASSUME RESPONSIBILITY
FOR ANY DAMAGE OR LOSS IN ANY FORM.

DATE(MM/DD/YYYY): 

APPLICANT'S NAME: 

Check your information and then press the SUBMIT button to send to Contact Canada