TEST Homestay Family Application

Family InformationStep 1 of 7

Home Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

APPLICANT #1 INFORMATION

Applicant #1 First Name *

Applicant #1 Last Name *

Applicant #1 Employer *

Applicant #1 Occupation *

Applicant #1 Email *

Applicant #1 Cell Phone *

APPLICANT #2 INFORMATION (if applicable)

Applicant #2 First Name

Applicant #2 Last Name

Applicant #2 Employer

Applicant #2 Occupation

Applicant #2 Email

Applicant #2 Cell Phone

Personal Reference First Name *

Personal Reference Last Name *

Relationship to Applicant *

Personal Reference Phone: *

Personal Reference Email: *

Would you prefer to host *

How many students can you accommodate for the Summer Intensive Program (3 weeks)? *

*Please note, students can share a bedroom for the Summer Intensive if there is adequate furnishings to accommodate two students.

How many students can you accommodate for the Full Year Program (10-11 months)? *

Why are you interested in hosting a student in your home? *

Are you able and willing to transport a student to various dance activities? *

Please explain:

Are you able and willing to mentally support/encourage students in their dance training?

Please explain:

Have you previously had a student stay in your home? *

Through what agency and what was your experience like?

When did you previously host students? *

Please list the dates (from - to)

What age of students did you host previously? *

What was the nationality of the students you hosted previously? *

TRAVEL TO VAB

Is there a city bus stop near your home (a bus that goes to Quadra Village)?

What is the approximate walking distance (in minutes) from your home to the bus stop? *

What is the approximate total time to walk and bus to VAB at 2713 Quadra Street? *

What is the bus number(s)? *

HOUSE INFORMATION

Number of levels in home *

Number of bedrooms in home *

Number of bathrooms in home *

Home ammenities *

Wireless internet
Cable TV
Netflix
Family computer
Garden
Bath tub(s)
Hot tub
Trampoline
Sports Equipment
Boat
Piano

Check all that apply.

Please upload photos of your home if possible.

Drop your file here or click here to upload You can upload up to 1 files.

Photo 1

A second photo can be uploaded here.

Drop your file here or click here to upload You can upload up to 1 files.

Photo 2 *optional

Outside areas *

Front Yard
Front Porch/Patio
Back Yard
Back Deck/Patio
No outside areas

Check all that apply.

Social common areas in the home: *

Do you have any household pets? *

If yes, please describe *

STUDENT BEDROOM INFORMATION

Bedroom furnishings provided to student *

Approximate square footage of student bedroom(s) *

Location in the home where the student(s) will sleep *

Typically there are how many occupants in your household (excluding the Applicant(s)) *

*If there are more than 4 occupants in your household (excluding the Applicant(s)), please email VAB with the necessary information for the additional occupants.

Home Occupant 1

This should be different than the Applicant information detailed in part one.

Occupant 1 - First Name *

Occupant 1 - Last Name *

Occupant 1 - Gender *

Female
Male
Other

Occupant 1 - Age *

Occupant 1 - Occupation *

Please put N/A if not applicable.

Occupant 1 - Relationship to applicant(s) *

Home Occupant 2

This should be different than the Applicant information detailed in part one.

Occupant 2 - First Name *

Occupant 2 - Last Name *

Occupant 2 - Gender *

Female
Male
Other

Occupant 2 - Age *

Occupant 2 - Occupation *

Please put N/A if not applicable.

Occupant 2 - Relationship to applicant(s) *

Home Occupant 3

Occupant 3 - First Name *

Occupant 3 - Last Name *

Occupant 3 - Gender *

Female
Male
Other

Occupant 3 - Age *

Occupant 3 - Occupation *

Please put N/A if not applicable.

Occupant 3 - Relationship to applicant(s) *

Home Occupant 4

Occupant 4 - First Name *

Occupant 4 - Last Name *

Occupant 4 - Gender *

Female
Male
Other

Occupant 4 - Age *

Occupant 4 - Occupation *

Please put N/A if not applicable.

Occupant 4 - Relationship to applicant(s) *

What is the primary language spoken at home? *

Does anyone in your home speak any other languages fluently? *

Please describe:

Describe your family's typical weekly schedule: *

List your family's hobbies and interests: *

Who is the primary cook in your household? *

What kind of food does your family typically eat at home? *

Does your family have any dietary restrictions? *

Please describe

Do you prefer the student to prepare their own breakfast? *

Yes
No, I will prepare it.

Do you prefer the student to prepare and pack their own lunch? *

Yes
No, I will prepare it.

What are your family's rules around use of kitchen, common areas, laundry room, television etc.? *

What is your family's religious denomination? *

Please write N/A if not applicable.

How actively does your family pursue your religion? *

Very actively
Weekly
Occasionally
Never

Does any occupant of your household smoke? *

What are your family's rules about smoking marijuana? *

Does anyone in your household smoke marijuana? *

Yes, but only occasionally
Yes, regularly
No

What are your family's rules about drinking alcohol? *

Are you experiencing any family issues that may impact the atmosphere of your home? *

Please describe:

Have any occupants recently suffered with depression, anxiety, or mental health concerns that may impact the atmosphere of your home? *

Please describe condition and any treatment:

Have any occupants been diagnosed with, or sought treatment for, alcohol or drug abuse? *

Please describe condition and any treatment:

Have any occupants been charged with a criminal offense? *

Please describe:

Has a recent criminal record check been completed for all occupants in the household over the age of 19? *

Yes, all occupants
Yes, but only some occupants
No

Is there anything else that a student needs to know about your household?

I am aware that in hosting a student, I am completely responsible for him/her. I am aware that if I fail to properly supervise a minor student, I could be held legally responsible. *

I Agree

I am aware that I am responsible for arranging adequate liability insurance to cover a student living in my home. *

I Agree

I agree to abide by the guidelines of the Host Family Agreement of Victoria Academy of Ballet. *

I Agree

Applicant 1 First Name *

*My typed name acts as my digital signature.

Applicant 1 Last Name *

*My typed name acts as my digital signature.

Applicant 2 First Name (if applicable)

*My typed name acts as my digital signature.

Applicant 2 Last Name (if applicable)

*My typed name acts as my digital signature.

Name

Academy

Vocational Division

Open Division

Summer Programs

TEST Homestay Family Application

APPLICANT #1 INFORMATION

APPLICANT #2 INFORMATION (if applicable)

TRAVEL TO VAB

HOUSE INFORMATION

STUDENT BEDROOM INFORMATION

Home Occupant 1

Home Occupant 2

Home Occupant 3

Home Occupant 4

OPEN DIVISION

VOCATIONAL DIVISION

ATTENDANCE

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Dance with us

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Your future

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