Student Homestay Application Form

Student Name
Last name		First name
Date of birth According to the date on your passport		Gender	Male Female
Nationality
Parent's email		Student's email
Members in your family
Name		Relationship
Name		Relationship
Name		Relationship
Name		Relationship
Name		Relationship
Do you have any medical problems (including allergies, optical, dental)? If yes, please give details:
Are there any foods that you cannot eat for health or religious reasons? If yes, please give details:
Many Canadian families have pets (For example: cats, dogs, birds, fish or others). Do you like pets?
	Yes No
Would you like to stay in a home with children or teenagers?
Children	Yes No No Preference
Teenagers	Yes No No Preference
What activities, sports, hobbies, or interests do you enjoy when you are not studying?
Additional Information:
Have you read and understand the financial commitments as explained in the Heritage Christian School International Student Application?
	Yes No
STUDENT: I agree that I have reviewed and all information is correct, and use this in replacement of my signature. Dated:
PARENT: I agree that I have reviewed and all information is correct, and use this in replacement of my signature. Dated:
Heritage Christian School (HCS) is collecting and maintaining the information requested on this form for the purpose of assessing the eligibility of International Students for International Education programs within its campus and for placement in a suitable home.