Homestay Family Application:                         Ref. # _______

Mr./Mrs./Ms. _________________

Family Name: ___________________________

First Name: ____________________________

Gender _____________ DOB ______________

Employment ____________________________

Spouse’s Last Name ______________________

Spouses First Name ______________________

Gender ________________ DOB ___________

Employment ____________________________

Home Address: _________________________________________________________________________

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City                                                                         Province                                             Postal

Phone No: ________________________ Fax: ___________________________________

Email: ____________________________ Web Page ______________________________

Nearest N/S Street ___________________ Nearest E/W Street _______________________

Route to Downtown ________________________________________________________________________

Family members:

Name                             Relationship               Gender           Occupation               DOB

 Gender Preferences ______________Age Preferences: From __________ To: _____________

Religion _________________________

Do you have pets? Yes_________ No_______________

Cat __________________ Dog _____________________ Other _______________________

Do you allow smoking in your home? Yes__________ No ______________Outside _________

No. Of rooms ______________ Shared/Private Bath ________________ Parking ___________

Describe how you will be able to interact with your host student:

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Interests: Sports: __________________________________________________________________________

Music: ___________________________________________________________________

Hobbies: ___________________________________________________________________

Other: ___________________________________________________________________

TV Programs: _______________________________________________________________

Favorites Foods_____________________________________________________________

Have you hosted international students before? If yes please explain

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How did you hear about us? __________________________________________________________________________

I UNDERSTAND THAT WHEN PLACED WITH A STUDENT BY BHS I AM A HOST FAMILY REPRESENTED BY BHS AND UNDER NO CIRCUMSTANCES WILL MY FAMILY HOST STUDENTS FOR SCHOOLS IN WHICH I HAVE RECEIVED STUDENTS FROM BHS THAT HAVE NOT BEEN PLACED BY BHS.

I WILL PROVIDE A CLEAN FURNISHED PRIVATE ROOM, WARM AND HOSPITABLE ENVIORMENT AND THE AGREED UPON BOARD. I ALSO UNDERSTAND THAT BOWERS HOMESTAY SERVICES IS NOT LIABLE FOR ANY DAMAGES OR LOSS CAUSED BY THE STUDENT.
 

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Host Family                                                                     Date

Please list two personal references:

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