Student and Visitor - Hospitalite Canada

Homestay Placement and International Students Services

APPLY NOW - Spring & Summer

Student and Visitor Application Form

Homestay Application

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 Homestay Application, click on the print icon to print this application.


First Name:
Last Name:
Company Name:
E-Mail Address:


Title:
First Name: *
Last Name: *
English Name (Optional):
Address:
City: *
Province/State:
Postal/Zip Code:
Country:
Nationality:
Home Phone #:
Work Phone #:
E-Mail Address:
Gender	Male Female
Nationality:
Date of Birth:	(example: November 12, 1974)


Parent Name(s):
Address:
City:
Province/State:
Postal/Zip Code:
Country:
Phone:
Email Address:


From what date:	(example: November 12, 2006)
To what date:	(example: December 14, 2006)
Homestay Choice	With Meals Without Meals
Knowledge of English	Beginner Intermediate Advanced
Which school Board will you be attending in Niagara:
School Start Date:	(example: December 14, 2006)
Do you have a:	Student Visa Visitor Visa Resident Visa Canadian Citizen None
Do you smoke?	YES NO
If yes, are you willing to smoke outside?	YES NO
Is a home with a pet acceptable?	YES NO
Do you have allergies?	YES NO
Do you have a physical disability?	YES NO
If yes, please explain:
Do you require special medical treatment?	YES NO
If yes, please explain:
Do you require a special diet?	YES NO
If yes, please explain:


I like to wake up:	Very Early When I have to
When I wake Up I like:	To be quiet To talk To listen to music
I go to bed at:
When I go out with my friends we like to:
I tidy up my own bedroom:	Yes No Someone does it for me
My attitude towards school is:	I like a lot It is ok I do not really like it
I usually do my homework:	right after school after dinner before going to bed
What is your personality like ? (outgoing, shy, cheerful, serious, hardwordking, optimistic, independent, quiet, neat,.. etc ):
Do you play any sports ? (Baseball, Basketball, Badminton, Ballet, Biking, Dance, Fishing, Fitness, Golf, Hockey, Skating, Horseback Riding,.. etc ):
Do you play any instruments ? ( Piano, Guitar, Violin, Cello, Flute, Trumpet, Singing,.. etc ) :
What are your passtimes? ( Movies, Music, Painting, Photography, Reading, Shopping, Video Games,.. etc ) :
Letter to the host family Please write a letter to tell us why are you applying to study in Canada:


Emergency Contace Name:
Emergency Phone:


Would you like us to arrange airport transportation for you? YES NO
Arrival Date:	(example: December 14, 2006)
Airport Name:
Airline:
Flight Number:
Arrival Time:	(ie. 00:00 hours - Ontario Local Time)
Arriving From:
Departure Date:	(example: December 14, 2006)
Airport Name:
Airline:
Flight Number:
Departure Time:	(ie. 00:00 hours - Ontario Local Time)
Departing From:


Would you like to purchase Medical Insurance through Hospitalité Canada? Yes No If yes, we will email you a form

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 Student or Visitor Guidelines? Read Guidelines Yes No
Do you and your representative accept the program disclaimer? Yes No

By submitting this application you acknowledge it true and binding