Host Registration Form

Personal Information
Please enter your accurate personal information in below boxes. All fields marked with (*) are required.
Your Name*
First Middle Name Last
Enter your full name .
Current Residence Information*
Street Address Address Line 2 City Province Postal Code
Home Phone Number*
Your home phone number.
Cell Number
If you use your cell number as your home phone number, please enter the same number here.
Work Phone Number
This field is optional. It can be used in case of any Emergency. We would not contact your work place to verify your details, unless required. We will notify you about it in advance before contacting your work place.
Your Email*
Enter Email Confirm Email

Enter your correct email address. This will be used as a primary source of contact.
Transportation
What is the nearest main intersection to your home?*
What is the closest subway station to your home? (if applicable)
How far away is the nearest bus stop? (Minutes)*
Can you pick-up students from the airport?*
Describe your Neighbourhood*

Family Details
Please enter your accurate family information in below boxes. All fields marked with (*) are required.
Number of family members.*
Please select number of family members currently residing in the house.
Your information
Enter details about yourself in fields below
Name*
First Last
Sex*
D.O.B*
DD slash MM slash YYYY
Occupation*
Member 2
Enter details about member #2 in fields below
Name*
First Last
Relationship*
D.O.B*
DD slash MM slash YYYY
Occupation*
Member 3
Enter details about member #3 in fields below
Name*
First Last
Relationship*
D.O.B*
DD slash MM slash YYYY
Member 4
Enter details about member #4 in fields below
Name*
First Last
Relationship*
D.O.B*
DD slash MM slash YYYY
Member 5
Enter details about member #5 in fields below
Name*
First Last
Relationship*
D.O.B*
DD slash MM slash YYYY

Other family info.
What is your status in Canada?
If you were not born in Canada, please specify how long have you lived here? (Years)
English must be the primary language spoken. Please list any other languages spoken in your home:*

Enter multiple languages seperated by ( , - Coma) or ( . - Stop sign) . Enter NA if none.
What are your family’s interests and hobbies?*
What is your religion (if applicable)?
Does anyone in your house smoke?*
Would you allow smoking outside your house?*
Do you have pets at home?*
List Pets*

List of pets you currently have. (Eg: Cat, Dog, Snake, Fish)
Are there any house rules that the students should know about? Please list*
(Enter NA if none)

Any special instructions or comments?*
Use the space below to provide any additional information about your Family or Home that you think may be useful or may benefit your application for this program. Enter NA if you do not wish to provide any other info.
By clicking on the submit button, I/We agree that the information that has been provided in this application is true and correct to the best of my/our knowledge. I/We understand that it is the Homestay family’s responsibility to review any home rules with the student(s) soon after arrival.
Hidden
Agreement
- I agree to the above Authorization statement.
Name*
First Last
Date*
DD slash MM slash YYYY
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Personal Information