Vancouver Central Homestay

Host Family Application

Family Information

FAMILY NAME

FIRST NAME

ADDRESS:

HOME TELEPHONE

WORK TELEPHONE

E-MAIL ADDRESS

LANGUAGES SPOKEN IN HOME (please list):

FAMILY MEMBERS AND YEAR OF BIRTH (please list):

Pets Yes No

FAMILY ACTIVITIES, INTERESTS, HOBBIES:

SPECIAL DIET Yes No
IF YES, PLEASE PROVIDE DETAILS:

Accommodations

Student Preference (select one): Male Female Does not matter

How many bedrooms do you have available for students:

Bathroom: Shared Private

Smoking? Yes No Outside Only

Internet: Yes No

Can the student use it? Yes No

What is the travel time from your home to downtown?

General

Homestay experience? Yes No If Yes, number of years:

Where did you hear about Vancouver Central Homestay?

Please provide two references, including name, phone number and relationship:

Reference #1

Reference #2

Feel free to contact us at any time: we'd love to hear from you.
If you have questions, comments or suggestions, please drop us a line.
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