Home Stay Form
Last Name * :
Given Name * :
Date of Birth:
Phone * :
Email * :
Home Stay Information
Home Stay Required:
Are home stay pets OK?
Are home stay children OK?
Do you smoke?
Dietary Restrictions/medical Conditions:
List your interests, activities, etc.:
Special Requests Fees (In Canadian Dollars) - Payable to the third party
Home Stay placement fee (non-refundable) $150.00
Airport pick-up ($100 one-way)
Health Insurance ($1.50 per day)
Health Insurance Start Date:
Health Insurance End Date:
Placement fee, airport pick up, insurance and one month home stay fee must be payable to the third party at the time of registration.
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