home stays Canada for ESL and foreign students

Home

ESL student application for HomeStays Canada
Please fill in the following information and you will be contacted by HomeStays Canada

First Name: Last Name:

Address:

City: Country:

Home Phone: Business Phone:

Email:

Please fill in the following information about your ESL studies in Canada.

School you will be attending:

The city the school is located in:

What is your arrival date in Canada?:

What is your departure date from Canada?:

How long will you need a Home Stay for?:

If you have an agent what is the name of the agent?:

What is your agent's address?:

What is the email address of your agent?:

Please fill in the following personal information for HomeStays Canada. Some of this information will be given to your host family.

Your area of Employment or Business or are you a student in your country :

Your hobbies and interests:

Languages you speak:

Please state the daily meals to be provided by your homestay? Breakfast, Lunch, Dinner, Snacks:

Do you have allergies? If so what are the allergies?:

Do you have any medical conditions your homestay should be aware of? If so what is this?:

Do you need internet access?

Can you live with animals?

Do you smoke?

Your Religion:

Are you male or female?:

Your Age:

What is your birthdate?

Do you need to be picked up at the airport?

Fill in the following to send further comments to HomeStays Canada.

Submitting this form to HomeStays Canada does not constitute a legal binding agreement between you and HomeStays Canada. HomeStays Canada will contact you shortly.