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Homestay Application Form

    Applicant Information

    Address City Postal Code
    E-Mail Home Phone Cellular Phone
    Building Type I my residence Available Date
    Gender Preference Age Preferences

    ( check all that apply )

    		 15-1819-2930 & Over How many

    rooms for students
    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? What other agencies or schools do you work with? Homestay Experience

    Family Information

    do not include other homestay guests

    Full Name

    (include lastname)

    		 Relation Date of Birth Gender Occupation

    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.


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