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Airdrie Christian Academy

Host Family Homestay Application

Host Family Homestay Application

Host Family Homestay Application Form

Thank you for making the important decision to host an international student at ACA! Becoming a host family is a wonderful opportunity to get to meet new people and learn about a different culture. Through this program, you will be expected to integrate an international student into your home, share our rich Canadian culture and ensure your student feels a part of your family. Remember, international students step out of their comfort zones to embark on life changing adventures so there will be some culture shock. However, your hospitality makes all the difference.

Hebrews 13:2-3 (ICB)

“Remember to welcome strangers into your homes. Some people have done this and have welcomed angels without knowing it.”
Personal Information (Applicant 1)
Applicant #1*
Prefix First Name Middle Name Last Name
Name of Employer*
Occupation*
Work Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Cell Phone
Work Phone
Email Address*
Date of Birth*
Date Format: MM slash DD slash YYYY
Driver’s License*
Immigration Status in Canada:*
- Canadian Citizen
- Permanent Resident/Landed Immigrant
Personal Information (Applicant 2)
Applicant #2
Prefix First Name Middle Name Last Name
Name of Employer
Occupation
Work Address
Street Address City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone
Work Phone
Email Address
Date of Birth
Date Format: MM slash DD slash YYYY
Driver’s License
Immigration Status in Canada:
- Canadian Citizen
- Permanent Resident/Landed Immigrant
Family Information
Please give a complete list of everyone currently living in your home
Family Information*
Name (First and Last) Gender DOB Relationship to Occupation

Click ⊕ icon to add more rows....
Shared Information
Residential Address*
Street Address City State / Province / Region ZIP / Postal Code
Our home is one of the following:
- Apartment / Condo
- Townhouse
- Semi Detached House
- Detached House
Number of levels*
Approximate square feet*
Age of House*
Length of time at current address*
Number of bedrooms available for hosting?*
Where are they located in the home?*
Number of bathrooms in the home?*
Where are they located?*
Will bathroom available to student be:*
- Private
- Shared
with whom?*
Give a brief description of the room your student will use (Describe location and how it is furnished eg. Bed size, desk, closet, phone line, internet etc)*
What languages are spoken in the home?*
What is the predominant language spoken in the home?*
If other languages are spoken in the home, do you and all family members consent to speak only English in the presence of your homestay student?*
- YES
- NO
Do you have any pets in your home?*
- YES
- NO
If yes, please provide type (Cat/Dog/Other) number(s), name(s), size(s)*
Have you ever hosted and international student in your home?*
- YES
- NO
If yes, briefly describe how long and what that experience was like?*
How did you hear about our program?*
Family Profile
This section is for you to write a family profile that will be shared with your student describing a typical day in your household and how you conduct the affairs of your house hold. Include personalities of family members, spiritual activities, hobbies, family rules/routines and weekend activities. Also explain why you are interested in hosting an international student.*
Preferences for hosting a Student
Please choose preferences for hosting a Student*
- Male
- Female
- Short Term
- Long Term
- No Preference
Some international students may have specific dietary requirements (i.e. Vegetarian, Vegan, Gluten Free, Dairy Free etc.) Can you respect and meet any dietary requirements?*
- YES
- NO
If No, please explain below*
How soon are you able to accept students into your home?*
Health Information
Are there any medical conditions or health concerns that will impact your ability to fulfil your obligations as a host family?*
- YES
- NO
If YES, please describe below:*
Are there any smokers in the home?*
- YES
- NO
Family Doctor*
Phone*
Dentist*
Phone*
Emergency Contact Information
Name of Emergency Contact (Could be a close friend or relative)*
Home Phone*
Cell Phone
Relationship*
Address*
Street Address City State / Province / Region ZIP / Postal Code
References
Please provide two references (each) we can contact regarding your homestay application. One personal reference and one professional reference.
REFERENCES FOR APPLICANT 1
Reference # 1*
First Name Last Name
Home Phone*
Cell Phone
Email*
Reference # 2*
First Name Last Name
Home Phone*
Cell Phone
Email*
REFERENCES FOR APPLICANT 2
Reference # 1
First Name Last Name
Home Phone
Cell Phone
Email
Reference # 2
First Name Last Name
Home Phone
Cell Phone
Email
We/I agree to the following statements:

We/I understand that the information provided on this homestay application will be used by Airdrie Christian Academy (ACA) to find the best possible homestay match.

We/I agree to abide by guidelines of the Homestay Program.

We/ I authorize ACA to release the information on this homestay application form to potential international students that match our family profile.

We/I agree that photos of our home and family may be shared with potential international students and their families for the purpose of the Homestay program.

We/I agree to consult with the Homestay Program Coordinator to find solutions to issues that may arise if we/I are unable to resolve them with the international student.

We/I understand that ACA reserves the right to move a student without advance notice if the homestay situation proves to be unsatisfactory.

We/I agree to assume all liability for loss or damage and we/I fully release and discharge ACA, its agents, employees, officers and Board members from any and all liability claims that may arise out of my participation in the Homestay program.

We/I declare that none of our children living in the home nor any minor children living in our home has a criminal record for any offence

We/I agree to resolve any disputes with ACA, KCES, or its representatives without resort to a court of law, and ACA will also hold itself to this agreement.
We/I understand that the information provided on this homestay application will be used by Airdrie Christian Academy (ACA) to find the best possible homestay match. We/I agree to abide by guidelines of the Homestay Program. We/ I authorize ACA to release the information on this homestay application form to potential international students that match our family profile. We/I agree that photos of our home and family may be shared with potential international students and their families for the purpose of the Homestay program. We/I agree to consult with the Homestay Program Coordinator to find solutions to issues that may arise if we/I are unable to resolve them with the international student. We/I understand that ACA reserves the right to move a student without advance notice if the homestay situation proves to be unsatisfactory. We/I agree to assume all liability for loss or damage and we/I fully release and discharge ACA, its agents, employees, officers and Board members from any and all liability claims that may arise out of my participation in the Homestay program. We/I declare that none of our children living in the home nor any minor children living in our home has a criminal record for any offence We/I agree to resolve any disputes with ACA, KCES, or its representatives without resort to a court of law, and ACA will also hold itself to this agreement.
Please check the box beside the statement:*
- WE/I HAVE READ AND UNDERSTAND THE CONTENTS OF AND ARE IN AGREEMENT WITH THE ABOVE STATEMENTS
Applicant #1 Initial*
Applicant #2 Initial
RELEASE FROM LIABILITY

By signing this form, we/I acknowledge that we/I have obtained insurance to ensure coverage against loss or damage to myself or my property. We/I understand that we/I must maintain adequate insurance for the entire time we/I host a student in my home.

We/I hereby fully release and discharge ACA, its agents, employees, officers and Board members, from any and all claims, causes of action, expenses, damages and demands of any and every kind and nature whatsoever, at law or at equity or pursuant to any statute, which we/I may have for any injury, loss or damage to any person or property arising in any way from my participation as a host in the Homestay Program

We/I shall indemnify ACA, its agents, employees, officers and Board members from any and all claims, damages, financial obligations or liabilities which may be brought or made against them as a result of any loss, damage or injury to any person or property caused by my acts or omissions.
By signing this form, we/I acknowledge that we/I have obtained insurance to ensure coverage against loss or damage to myself or my property. We/I understand that we/I must maintain adequate insurance for the entire time we/I host a student in my home. We/I hereby fully release and discharge ACA, its agents, employees, officers and Board members, from any and all claims, causes of action, expenses, damages and demands of any and every kind and nature whatsoever, at law or at equity or pursuant to any statute, which we/I may have for any injury, loss or damage to any person or property arising in any way from my participation as a host in the Homestay Program We/I shall indemnify ACA, its agents, employees, officers and Board members from any and all claims, damages, financial obligations or liabilities which may be brought or made against them as a result of any loss, damage or injury to any person or property caused by my acts or omissions.
Please check the box beside the statement:*
- WE/I HAVE READ AND UNDERSTAND THE CONTENTS OF THIS AGREEMENT WITH AIRDRIE CHRISTIAN ACADEMY.
Applicant #1 Signature*
Date*
Date Format: MM slash DD slash YYYY
Applicant #2 Signature
Date
Date Format: MM slash DD slash YYYY

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