--- Calgary Student Home Stay ---

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For more information please send us your questions and comments by filling out the form below or you may reach us at:

Box 9, 6490 Old Banff Coach Road, SW,
Calgary, Alberta, T3H 5R8
Phone: (403) 249-9700

REGISTRATION

CALGARY STUDENT HOMESTAY CONTACT INFORMATION

Family Name:

Given Names:

Email:

Phone:   Fax:

Age:           Male Female

Nationality:

Do you smoke? Yes No

Are you O.K. to stay in a non-smoking home? Yes No

Are you okay with pets (most often a dog or cat) in the house? Yes No

Please List any allergies or medical conditions that we should know about:

Have you ever been abroad? (Where? For how long?)

Would you prefer to live with a family: with children without children

Is there any other important information that we should know about, so that we
can better match you to a family?

EMERGENCY CONTACT INFORMATION

Name:

Relationship:

Address:

Home Phone #:   Business Phone #:

Placement Fee
You must pay Calgary Student Homestay a $250.00 Homestay Placement fee before you come to Canada. This fee is non-refundable and includes Airport Pick-up upon your arrival in Calgary. This fee and your arrival notice must be received by Calgary Student Homestay at least two weeks in advance. Otherwise, homestay arrangement and pick-up services are not guaranteed.

Monthly Fee
The monthly rental fees are paid directly to your host family once you arrive in
Canada. Which type of arrangement are you interested in (please check)?

Accommodations & 3 meals/day        Monthly Fee = $750.00

Accommodation & 2 meals/day          Monthly Fee = $650.00

There is also a $200.00 security deposit that you must pay your host family
on arrival. You will get your security deposit back if you give your family
two weeks notice before departing, and do not incur any costs or damages
to the family.

WHEN DO YOU NEED A HOME STAY AND WHEN ARE YOU ARRIVING?Dates you need homestay accommodations:

FROM (M/D/Y):

TO (M/D/Y):

Please tell us when you are arriving, so we can tell your host family:

Arrival Date/Time in Calgary:

Airline:

Flight:

Departure City:

PROCEDURES1. Send this form as well as your $250.00 Homestay Placement fee to:

Box 9, 6490 Old Banff Coach Road, SW,
Calgary, Alberta, T3H 5R8

2. We will send you information about your host family as soon as possible,
    including their address and phone number so you can contact them in advance
    of your arrival.

3. Pay your host family the security deposit and first month's rent on arrival, and
    subsequent month's rent on the first day of each month.

ACCEPTANCE OF RESPONSIBILITY FOR HOMESTAY:  - I agree to give my host family at least 2 weeks notice before leaving. Otherwise, I   forfeit the $200.00 deposit.

- I assume complete responsibility for my personal financial needs, including phone calls. Under no circumstances are long-distance calls to be made on homestay family phone (use calling card).

- I will respect the rules and guidelines outlined by my host family.

- I will respect and adhere to Canadian laws and regulations.

- I will inform Calgary Student Homestay immediately if there are any problems or issues between my host family and myself.

- I understand that Calgary Student Homestay will do their best to ensure that the home stay arrangement will be a strong match, but that there are no guarantees.

Signature:
Date (M/D/Y):