* information required
Agency email*
Partner/Agency*
Branch*
Consultant Name
School student will attend classes*
Which Campus are you attending classes?
City* VancouverToronto
Student Full Name*
Student Email Address*
Cellphone Number*
Do you use WhatsApp on this line?* YesNo
Do you use any other mobile apps? If so, please specify bellow. (number/App)
Date of Birth*
Gender* MaleFemale
Emergency Contact: (Name*) Emergency Contact: (Phone Number)*
Home Address
Nationality*
First Language*
Arrival Date at Homestay Family*
Departure date from Homestay Family*
If sharing the bedroom, please add the name of the other guest
Indicate type of bed preferable* Double bed2 twin bedsDon't have preference
Type of Bathroom* SharedPrivate (Extra fee applies, upon availability)
How many meals?* 2 meals per day (Breakfast and Dinner)3 meals per day (Breakfast, Lunch and Dinner)
Do you have any dietary restrictions? (Vegetarian, Vegan, Hallal, etc.) Yes (Extra fee may apply)No
If yes, explain:
Do you have any allergies?* YesNo
Do you have any health conditions that would interfere in the placement? (Example: diabetes, high Blood pressure...) YesNo
Do you take any regular medication? YesNo
Do you accept a house with pets? If you are not allergic to dogs and cats, we advise you to mark “yes”, by doing so, the chances that we will find a family that matches your other preferences are increased.* Yes, any petsDogs onlyCats onlyI prefer no pets
Do you have any preference or special requirements?* YesNo
Would you like to request Transfer Service? (strongly recommended for minor students)* Yes, Pick-up onlyYes, Pick-up and Drop-offNo, I don't need transfer service
Do you have your Flight information? (If yes, please fill out the information bellow)* YesNo
CypressCypress