l Homestay Application Form Applicant Information Address City ---VancouverBurnabyRichmondNew WestminsterNorth VancouverWest VancouverOther Postal Code E-Mail Home Phone Cellular Phone Building Type ---housetownhouseduplexmultiplexcondo/apartmentmultiplexbasement suite I ---ownrentleaseother my residence Available Date Gender Preference ---malefemaleeither Age Preferences( check all that apply ) 15-1819-2930 & Over How many rooms for students ---1234+ What Languages Other than English do you speak? What kind of Pets do you have? How Long have you lived in Canada? How Did you hear about us? ---Google SearchGoogle AdFacebookFacebook AdInstagram AdBing/Yahoo SearchOnline AdvertisementPrint AdvertisementFriend/Colleagueother What other agencies or schools do you work with? Homestay Experience ---none1-4 years5-9 years10+ years Family Information do not include other homestay guests Full Name(include lastname) Relation Date of Birth Gender Occupation ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother ---MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest ---malefemaleother Criminal Record Check Yes, I agree to provide Canada Homestay Organization with current Criminal Record Checks for all adults * Canada Homestay Organization will not reimburse costs for criminal record checks. Comments
