THE LANGUAGE CIRCLE HOMESTAY PROVIDER REGISTRATION FORM
 
 
 
 

FAMILY INFORMATION

Family Name: 

First Name: 

Age: 

Occupation: 

Spouse/Partner's Name: 

Family Name: 

Age: 

Occupation: 

Full Address:

Nearest Major Cross Street: 

Telephone Home:

Telephone Work: 

Fax: 

E-mail: 

May we give your e-mail address to students we have placed with you?:

NAME ALL OF THE OTHER PEOPLE LIVING IN YOUR HOME, THEIR AGES AND RELATIONSHIP:

Children not living at home? Please list their names and ages::


HOMESTAY REGISTRATION INFORMATION

  • Do you smoke?
  • Do you allow smoking in your home?
  • Do you have any pets? What kind?:
  • Languages spoken in the home:
  • Other languages spoken:
  • Do you prefer Homestay students to be:
  • Age Preferred:
  • Nationality:
  • Bedroom(s) for student(s): How many:
  • Furnishings:
    Bed (not a cot or sofa-bed)
    Desk
    Closet
    Dresser
    Night-table
  • Do you have a computer that students could use?
  • Internet access? Hrs/day??:
  • Do you allow drinking in your home?
  • Do you have a musical instrument that a student could use?
    If Yes, which one?:
  • Does anyone in your family have any serious medical problems?
    If Yes, please explain:
  • Describe your family's diet:
  • What do you and your family enjoy doing?:
  • Would someone be able to let the student in if they arrive in Hamilton during the day time?

    I have read, understand and agree to the Homestay Guidelines as outlined. The Language Circle is not liable for any damages or costs incurred by Homestay students.

    Date: 



    PLEASE NOTE: Completion and submission of this form is not a guarantee of Homestay provider acceptance. You will be contacted shortly so that a home visit can be arranged prior to approval of this application.
    • The Language Circle: Teaching small group ESL classes, English Language School located in Hamilton, Ontario. Canada Products