Applied Linguistics Centre::Homestay

Homestay Student Application Form

HarvestHomes Inc.
Winnipeg, Mb.
204-771-5109
harvesthomesinc@hotmail.com

Personal Information

First Name:

Last Name:

Gender:
Male Female

Date of Birth:

Home Address

Street:	Home Phone:
City:	Email:
Province/State:	Fax #:
Country:

Contact Person

Name:

Phone #:

Arrival Information

Date of arrival:	Time of Arrival:
Airline:	Flight Number:
School/University:	Length of stay:

Personal Characteristics

What are your hobbies or interests?:
What is your preference regarding pets?:	Pets OK No pets
Do you like Sports?	Yes No
Do you have any siblings?	Yes No
List some of your likes or dislikes:

HarvestHomes Inc. will do their best to accommodate you in a comfortable, safe home but cannot guarantee all your preferences will be met.

Your Homestay Includes:

A comfortable, clean and safe home
Three healthy meals per day.
Television, Telephone and laundry facilities.
Internet access.
Convenient Bus Route
A kind, caring, supportive family environment.
Help with your English program.
The opportunity to participate in family and Canadian activities.
Familiarizing you with your new city.
Counselling if needed.

Homestay Fees:

Initial Placement Fee: $200.00

This fee includes:

Pick up from bus, train or airport.
City information package and orientation to your school.
A complimentary long distance calling card.
Complimentary Luggage Spotters.
Ongoing support and counseling where requested.
24 hour emergency assistance.

Homestay Rates:

$600 per month 18 and over.
$800 per month under eighteen.
$30.00 per day up to $600.00(daily rate)

HarvestHomes Terms and Conditions:

Homestay students must provide proof of Medical Coverage prior to placement.
Placement Fee is required at time of application and is non-refundable.
HarvestHomes will provide you with information about your Homestay family asap.
A deposit of $300.00 is required once placement is secured.
Monthly homestay fees must be provided one week prior to your monthly arrival date.
If students travel during your homestay, rates will not be reduced for periods less than one month.
All cheques are payable to HarvestHomes Inc.

Our courteous staff at HarvestHomes will greet you upon your arrival and introduce you to Winnipeg and your host family. We will do whatever possible to make your Homestay enjoyable and ensure a rich English learning experience is had by our guests and Herzing College. HarvestHomes Welcomes You to Canada!!

Phone: 204-771-5109
Fax: (Herzing Fax #)
Email: harvesthomesinc@hotmail.com.
Winnipeg, Mb., Canada R2H 1S3

Are you allergic to animals? Yes No	If so, which animals?
Are you allergic to any foods? Yes No	If so, which food(s)?
Are you allergic to anything else? Yes No	If so, what?
Do you have any medical conditions? Yes No	Please list them?
Are you taking any medications? Yes No	Which medications?
Do You have Medical Insurance? Yes No	Insurance carrier: Plan/Policy Number:
I understand medical insurance is required. I agree to acquire complete medical coverage prior to leaving my country or upon arrival in Winnipeg,Manitoba. I understand that HarvestHomes Homestay Coordinator, Herzing College or my Homestay family cannot assume responsibility for my medical expenses or liabilities.