Spouse's Last Name:
Spouses First Name:
Home Address, City, Province, Postal
Nearest N/S Street:
Nearest E/W Street:
Route to Downtown:
/ Date of Birth
Number of Dependents:
Gender: Age: Religion:
Do you allow smoking in your home?
Type of Home
No. of rooms available
Describe how you will be able to interact with your host
Have you hosted international students before? If yes
How did you hear about us?
Please list two personal references
(Name, Relationship, Phone Numbers):
BY SUBMITTING THIS ONLINE FORM, I UNDERSTAND THAT WHEN PLACED WITH A STUDENT BY
BOWERS HOMESTAY SERVICES (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 ENVIRONMENT AND THE AGREED UPON BOARD. I ALSO UNDERSTAND THAT
BOWERS HOMESTAY SERVICES IS NOT LIABLE FOR ANY DAMAGES OR LOSS CAUSED BY THE
I also understand that I will be paid for the time the student occupies
the room only.