Bowers Homestay and Educational Services of Canada

Student Application Form



Family Name: 

First Name:     

Sex:     Male      Female

Birth date:          Age:    
                               
DD/MM/YYYY

Permanent Home Address:

Phone No:      Fax:    

Email:      

Passport:

Length of stay in Canada?  

Where in Canada?

Date/Time 0f Arrival:  Flight No:

Do you require Airport Pick up?         Yes       No

School or College attending?         
Do you want us to register you?    Yes     No

Family Members:

      Name                  Relationship       Occupation                          Age

 1.

 2.

 3.

 4.

Medical Information:

Do you have any chronic medical illness?      Yes      No          If yes, please explain:

Are you currently under Doctors care?      Yes      No              If yes, please explain:

Are you allergic to anything?  (E.g.: medicine, smoking, food or pets)    Yes      No  
If yes, please explain:    

Do you smoke?      Yes      No  

Personal Characteristics and Interests:  Are you?

Energetic     Quiet

Sociable       Calm

Outgoing    Reserved

Like to spend a lot of quiet time at home    Enjoy a very social life

Music:

Sports:

Hobbies:

Do you prefer a host family with:    children      other student's      None  

Other Comments/Information:

How did you hear about us?

 

BY SUBMITTING THIS ONLINE FORM, I UNDERSTAND THAT BOWERS HOMESTAY SERVICES WILL SELECT A FAMILY FROM THOSE AVAILABLE, BASED ON THE INFORMATION THAT I HAVE PROVIDED AND THAT THEY CANNOT GUARANTEE THAT ALL OF MY PERSONAL PREFERENCES WILL BE MET. I ALSO UNDERSTAND THAT BOWERS HOMESTAY SERVICES IS NOT LIABLE FOR ANY LOSS OR DAMAGES.

 

 

 

Bowers Homestay - Your home away from home�

Last updated:  June 25, 2010 09:21 PM

Temporary Difficulties with the Online Forms may result in a Frontpage error - this means that your submission may  bounce back to you.  If this happens, you may want to use the printable form or try again later.  Notify the webmaster of this problem via email at info@canadahomestay(dot)com.