HOMESTAY PROGRAM    -    STUDENT APPLICATION     -     HOMESTAY FAMILY  APPLICATION

 

HOMESTAY FAMILY APPLICATION

CONTACT INFORMATION:
1. First Name: 2. Last Name:
3. Address:
4. Postal code:
5. Phone: 6. Fax:
7. Cell: 8. Email:
FAMILY INFORMATION:
9. How many members?
10. Do you have any children? (yes / no)
11. Children's names:
12. Children's ages:
13. Occupation:
14. Hobbies:
HOME:
15. How many bedrooms?
16. How many rooms available for students?
17. Are the student's room(s) private? (yes / no)
18. If No, How many others in room?
19. Does the room have a phone jack or could one be installed?
20. Is there a computer available?
21. Washroom shared?
22. Is washroom on the same floor as students room?
23. Are there pets on the premises?
24. If Yes, What kind of pet?
25. Is smoking allowed?
26. Comments:
TRANSPORTATION:
27. How far to the nearest bus stop
28. How many buses to the city center & Red River College?
REFERENCES:
29-1.
29-2.
30. Criminal check? (yes / no)
HOMESTAY PREFERENCES:
1. Student Age preference:
3. Gender Preference:
4. Nationality:

                                              

Phone:      204-479-9946 

Fax:        204-284-4174

Email:    polartrails@canada.com ,   www.polartrails.com

POLAR TRAILS INC.  148 BARTLET AVENUE, R3L 0Z1, WINNIPEG, MB  CANADA