Homestay Family Application Form - Canada Prime Consulting

Contact Information

Contact Name (required)

E-mail Address (required)

Home Address & Postal Code (required)

Telephone Number (required)

Cellphone Number (required)※please be sure to input the phone number you can get.

Family Information

Family Member 01(Contact Person)

First Name (required)

Gender (required)

1st Language (required)

Occupation (required)

Hobby

Date of Birth (required)※Please input "-" if you input as manual.

Family Member 02

First Name

Gender

1st Language

Occupation

Hobby

Date of Birth※Please input "-" if you input as manual.

Family Member 03

First Name

Gender

1st Language

Occupation

Hobby

Date of Birth※Please input "-" if you input as manual.

Family Member 04

First Name

Gender

1st Language

Occupation

Hobby

Date of Birth※Please input "-" if you input as manual.

Family Member 05

First Name

Gender

1st Language

Occupation

Hobby

Date of Birth※Please input "-" if you input as manual.

Some Question

Can you host both male and female students? (required)

If no, which gender do you prefer?

Do you have pets? (required)

If yes, what kind?

Number of years experience in home stay business. (required)

How many rooms are there to accommodate in your house? (required)

Have you or anyone living with you ever had a criminal record? (required)

Can you pick up and drop off students at the Airport? (required)

Can you host minor students? (required)

Is Wireless Internet available? (required)

Do the students' rooms have windows? (required)

Are a desk, chair, and light available for each student? (required)

Do you have a separate entrance for the students? (required)

Do the students share bathrooms, or have their own? (required)

Please describe yourself and your family. (required)

Transportation to downtown Vancouver. How long? By Skytrain/bus? Zones? (required)

Is there a community centre or similar facilities (i.e. library, gym, swimming pool..etc) near your place? If yes, how far away is it? (required)

Is there a shopping centre or other entertainment facilities (i.e. movie theatre, bowling...etc) near your place? If yes, how far away is it? (required)

Please describe the view from your place (i.e. mountains, lakes, downtown...etc) (required)

Do you accept that the fee for non shared room $29.00 per night? (as of Sep 2019) (required)

Confirmation

I confirmed certify that above information is true and correct, and will inform Canada Japan Consulting Services Ltd. immediately if there are any changes.

Name(Signature) (required)

Signature Date (required)※Please input "-" if you input as manual.