Student Homestay Application Form

Always Supporting Learners

Valuing Individuals • Fostering Pride • Expanding Opportunities

 

Personal Information

First name* Middle name
Last name* English name (if any)
Sex* Date of Birth (day/month/year)*
Male Female
Height Weight
cm kg
Address* City*
Country* Postal Code*
Telephone number* Fax number
Email Address*  
 

Family Members

  
Name* Relationship* Age* Occupation*
Name* Relationship* Age* Occupation*
Name* Relationship* Age* Occupation*
Name* Relationship* Age* Occupation*

Preferred Characteristics of Homestay Family*
Prefer to be with other young people Prefer no other children
Happy to live with a retired couple Prefer a quiet home
Prefer an active family Prefer a vegetarian diet
Happy to be in a home with another international student Rather not live in a home with inside pets like cats or dogs
Other  

if you feel additional information will be required by us please make note of it here

Your Character and Interest*
Outgoing Studious
Quiet Energetic
Independent Athletic
Adaptable

Shy
Cheerful

Sociable

Other  

if you feel additional information will be required by us please make note of it here
What are your favorite foods?*  
 
Least favourite foods include?*  
 
Do you play a musical instrument? If so, which one(s)?*
 
Are you interested in playing sports? If so, which one(s)?*
 
Are you interested in:*  
Art Dance Drama Computers
What are your favourite school subjects?*  
 
How long have you studied English?*  
 
Briefly tell us about yourself. Describe your personality, ambitions and why you chose to study
in Canada.*

Your Medical Information
Do you have any allergies?*  
Yes No  
If Yes, please describe your allergies and what treatment you use:
Are you under a doctor's care at present?*
Yes No  
If Yes, please describe:  
Do you have any medical conditions that we need to know about?* e.g., asthma
Yes No  
If Yes, please describe:  
Do you regularly take any medications?*
Yes No  
If Yes, please describe:  
Do you smoke cigarettes?*  
Yes No  
Please note that B.C Medical does not cover dental work. Please ensure that any dental problems are taken care of before you leave for Canada, as it might be less costly at home.

Emergency Contact Information
In case of an emergency we should contact/notify:
First name* Last name*
Address* City*
Country* Code*
Relationship*  
 
Telephone number* (Home) Telephone number* (Work)
Telephone number* (Cell) Fax number
   

I understand a host family will be selected from those available based on information which I have provided and there is no guarantee that all of my personal preferences will be met.

I agree to the terms outlined in the Participation Guidelines(PDF 25Kb).
I agree to the terms outlined in the Sea to Sky School District International Student Orientation Handbook (PDF 167Kb), access to which is provided through the District International Education website.