C&M Homestay Agency - Being A Host


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Thank you for choosing C&M Homestay Agency^TM partners to be your Homestay. To begin your wonderful journey, please fill out the form below accurately and we will be in touch with you once we have verified your information. Download form in PDF.

Student Personal Information

Last Name:
First Name:
Mailing Address:
e-mail:
Phone #:
Gender:
Birth Date:

Accommodation Expectation

Please select the city of your accommodation request:
Please select the type accommodation you are requesting:

Please select the best description of your expectations:

Please use the space below to describe yourself or other expectations of your accommodation:

Please indicate if you can stay with a family that has:
Children Teenagers Other Students
Pets:

Meal Options

Please select your meal plan:
Please list below your food allergies or the type of food that you do not eat:

Education Information

Indicate the school you will attend in Canada:
Indicate the School Campus(if applicable):
Please select your english proficiency:

Medical Information

Please use the space below to list any medical conditions or allergies you may have:

Do you smoke?:
Will you accept placement in Homestays where there are smokers?:

Emergency Contact Information

Name of Contact:
Relationship:
Phone# of Contact:
e-mail of Contact:

Agency Information

Name of Agency:
Contact Person:
Phone#:
e-mail Address:

Additional Information

Date of arrival to Canada:
Date of departure:
Do want airport pick-up?:

Do want airport drop-off?:
If you require airport pick-up, please provide the following:
Flight Number:
Arrival Time:

** By clicking the "Submit" button, you certify that you have read and understood the C&M STUDENT HOMESTAY STANDARD AGREEMENT. You also certify that you agree to ALL the Terms and Conditions indicated in the C&M STUDENT HOMESTAY STANDARD AGREEMENT.