Homestay Placement and International Students Services

Host Family Application Form

Please fill-out all aspects of this application. We require all information to be completed to the best of your knowledge. Should you have some missing information, please do not forget to forward missing information, as soon as possible, in an email. Here is the Host Family Application, click on the print icon to print this application.
*Please consider using the following online application.


Primary Contact
 
Title:
First Name: *
Last Name: *
Age Range:
Occupation:
Email:
Home Phone #:
Work Phone #:
Cell Phone #:
 
Home Information
 
Address:
City:
Province:
Postal:
Country:
Name of your Neighborhood:
What are the closest Public and Catholic Schools to your home?
Catholic School:
Public School:
What are the closest Public and Catholic High Schools to your home?
Catholic High School:
Public High School:
 
Secondary Contact
Title:
First Name:
Last Name:
Age Range:
Occupation:
Email:
Home Phone #:
Work Phone #:
Cell Phone #:
 
Other Family Members
 
Family Member1:
Date of Birth:
(example: November 12, 1974)
Relationship:
School:
 
Family Member2:
Date of Birth:
(example: November 12, 1974)
Relationship:
School:
 
Family Member3:
Date of Birth:
(example: November 12, 1974)
Relationship:
School:
 
Family Member4:
Date of Birth:
(example: November 12, 1974)
Relationship:
School:
 
Describe The Room & In-Room Amenities
 
House Style:
Total Bedrooms:
Total Bathrooms:
Total Student Bedrooms:

Please describe student room (twin, double, queen, two beds for double placement).


Please include information about availability of window, balcony, night table, lamp, desk, chair, closet, mirror, TV, clock radio, Internet access, computer, telephone, etc. Please include bed size (twin, double, queen).


Room Location:
(Basement, Main Floor, etc.)
Bathroom Facilities  Private   Shared  
 
If shared, how many people share the bathroom:
 
If more than 1 room is available, please describe the second room (number of beds, amenities, etc.). Also indicate location and if the bathroom is private or shared.



 
Do you have pets?  Yes   No  
If yes, please describe:



 
Do you prefer male or female students?  Male   Female   Either  
 
What age groups are you willing to host?
 
Do you smoke?  Yes   No  
 
Do you accept smokers?  Yes   No  
 
Please describe family activites and hobbies:



Are there frequent guests in your home?  Yes   No  
If yes, please describe:



 
Languages Spoken At Home
 
Language 1:
Language 2:
Language 3:
 
Additional Information
 
Previous Homestay experience?  Yes   No  
If yes, how many years?
Through which programs?



Please provide us with 2 references (personal, volunteer or employment). Please provide their name, relationship to applicant and a contact number.


Reference 1
Full Name:
Relationship:
Phone:
Reference 2
Full Name:
Relationship:
Phone:
 
Profile
 
Availability:   Year Round
Academic Year
One Semester at the Time
Winter Camp (Jan/Feb)
Summer Camp
Short Term

Vegetarian  Some Members
Can Accomodate
Can NOT Accomodate
House Rules:


Hobbies (Primary, Secondary, Children. Please list 3-4 per person):


Why do you want to host an international student?


 
Homestay Program Disclaimer
 
This homestay disclaimer applies to all participants in this homestay program including hosts, applicants, affiliates, students and clients. I/We have read and understood the conditions and guidelines outlined on the Hospitalité Canada Ltd. website and it's applications.

I/We understand that Hospitalité Canada Ltd. including all company services, executives, employees and websites are acting as independent agents who are not guaranteeing the quality of the relationship between the homestay student and the host family, or between student and the educational institution, or other relationships.

I/We understand and assume any and all risks related to my participation in this program, and I/We agree to release and hold harmless Hospitalité Canada Ltd. and each of their respective employees, agents, and representatives from any and all liability of claims should any injury, loss, or damage occur during this homestay or any other service offered.

I/We understand that if I/we participate in this program that I/we will purchase my/our own insurance whether medical, emergency, liability, damage, home, vehicle and/or any other types of insurance which may be necessary, should any claims, damages or penalties arise. Students should contact their own your insurance broker, travel agent, or insurance provider for more details.

I/We undertand that Hospitalité Canada Ltd. does not assume any responsibility for any injuries, losses, damages, problems or accidents that might occur during a homestay or a program. I/We further understand that any actions that take place among the homestay family, educational institution and student are not sanctioned by Hospitalité Canada Ltd. nor do I hold Hospitalité Canada Ltd. responsible for any reason.

Do you agree to the Host Family Guidelines? Read Guidelines
Yes   No  
Do you and your representative accept the program disclaimer?
Yes   No  
 
By signing or submitting this application you acknowledge it true and binding.