l Homestay Application Form Applicant Information Address City —Please choose an option—VancouverBurnabyRichmondNew WestminsterNorth VancouverWest VancouverCoquitlamPort CoquitlamPort MoodySurreyOther Postal Code E-Mail Home Phone Cellular Phone Building Type —Please choose an option—housetownhouseduplexmultiplexcondo/apartmentmultiplexbasement suite I —Please choose an option—ownrentleaseother my residence Available Date Gender Preference —Please choose an option—malefemaleeither Age Preferences ( check all that apply ) 15-1819-2930 & Over How many rooms for students —Please choose an option—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? —Please choose an option—Google SearchGoogle AdFacebookFacebook AdInstagram AdBing/Yahoo SearchOnline AdvertisementPrint AdvertisementFriend/Colleagueother What other agencies or schools do you work with? Homestay Experience —Please choose an option—none1-4 years5-9 years10+ years Family Information do not include other homestay guests Full Name (include lastname) Relation Date of Birth Gender Occupation —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—malefemaleother —Please choose an option—MotherFatherGrandfatherGrandmotherSonDaughterSisterBrotherCousinUncleAuntNephewNieceCommon-LawOtherNo RelationHomestay Guest —Please choose an option—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 r Having Issues with submitting the form? We have a simpler backup form just in case. Click Here
