Homestay Host Family Application Form

Please complete as best as possible and then press the SUBMIT button to send the form to Contact Canada.

We currently require more family registration in the following cities...

  • Victoria, BC
  • Vancouver, BC
  • Burnaby, BC
  • North Vancouver, BC
  • West Vancouver, BC
  • Richmond, BC
First Middle Last Relationship Occupation Birth Date First language (native) Second language
Briefly describe your family′s hobbies and interests
Would you be willing to have your student/visitor participate in family activities?
Yes   No
Are cigarettes, alcohol or marijuana consumed in your household?
Cigarettes   Alcohol   Marijuana   None
Will your student/visitor be allowed to smoke in your home?
Yes   Yes (Outside only)   No
Will your student/visitor be allowed to consume alcohol in your home?
Yes   Yes (Moderate)   No
Do you have pets?
Yes   No  
Please describe the quickest public transportation route (by bus or train) to the downtown area from your house (include bus #(s) & approx. length of time)
Please indicate the type of your home
Acceptable student/visitor age range
Teenager   Young adult   Adult   Senior   Family (e.g. mother and child)
Which students are you able to accept?
Female   Male   Either
During what time of the year will you usually be able to host students/visitors?
Spring   Summer   Autumn   Winter
How long would you be willing to host students/visitors in your home?
Less than a week   1-4 weeks   1-3 months   3-6 months   Over 6 months
The possibility of providing the Meal
One meal / day   Two meals / day   Three meals / day   Negotiable
Please indicate the number of rooms available in your house and how many beds there are per room.

Do you have internet access at home? (Wi-Fi)
Yes   No
Do you have previous experience as a host family?
Yes   No
Please list any homestay programs that you hosted with in the past or currently host for.
Please briefly tell us about your motivation to become a host family.
Is there anything else you would like us to know about you and your family?
Please attach a recent (not older than one year) family picture. Optional: Upload pictures of your home and student rooms.
Where did you hear about Contact Canada? If you don't remember choose "Other" and type "Don't remember".
Search engine   Social media   Other website   Job posting site   Referred by a friend   Another host family   A staff member   Other

Please give two references (including full names, telephone numbers, and your relationship)
Name Relationship Phone Number
I agree and understand that Contact Canada or its agents do not assume responsibility for any damage or loss in any form.
I understand and agree that according to Contact Canada's One Nation Policy, I may not host other Japanese students/visitors at my home for any duration I host students/visitors for Contact Canada.
I agree to provide a room with a desk and chair, appropriate light and a bed for all students/visitors from Contact Canada I will host.
Check your information and then press the SUBMIT button to send to Contact Canada.