Family Information

    SURNAME: (required)

    GIVEN NAME: (required)

    ADDRESS

    CITY:

    POSTAL CODE:

    HOME Telephone: (required)

    MOBILE Telephone:

    EMAIL: (required)

    DATE OF BIRTH (dd/mm/yy):

    List all members living in your home

    Full Name:

    Gender:

    DOB (dd/mm/yy):

    Relationship:

    Additional Family Members (Please list all family members residing in the home. Please note DOB and relationship.)

    Pet Information*

    PETS

    IF YES, PLEASE PROVIDE Type, Size and Breed:

    Family Activities, Interests, Hobbies (please list)

     

    Diet Information

    Families are expected to provide three healthy, adequate meals a day for the students and easy access to snacks. Students should eat dinner with the family.

    DO YOU HAVE ANY SPECIAL DIETARY PRACTICES OR RESTRICTIONS?

    Accommodations

    STUDENT PREFERENCE (select one):

    How many private BEDROOMS do you have available for students?

    BATHROOM:

    SMOKING?

    INTERNET:

    Can the student have Internet access in your home?
     

    General

    Do you have any Homestay experience?

    If Yes, number of years:

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

    Reference #1

    Reference #2

    Please enter the following code: captcha

    This 'code' is to validate that you are a person & not an Internet spambot.

     

     

    After completion of a home interview, Vancouver Central Homestay Ltd. requires the applicant and all residents (who are 19 years or older) in the household to provide a current criminal record check and will require a new criminal record check every 3 Years. Vancouver Central Homestay Ltd. will NOT PAY for the fees required for the criminal record check. If your criminal record check returns with a negative reply, we will not be able to provide you with students, nor will Vancouver Central Homestay Ltd. be responsible for reimbursement of the fees. (See the following link for further details: http://www.rcmp-grc.gc.ca/en/criminal-record-and-vulnerable-sector-checks).