ALDERGROVE CHRISTIAN ACADEMY

INTERNATIONAL PROGRAM

HOMESTAY HOST AGREEMENT

Dear Applicant:

Thank you for your interest in Aldergrove Christian Academy. We are delighted to share with you our information package for the International Program.

Aldergrove Christian Academy was formed in 1992 by concerned parents who wanted to provide their children with quality academic and spiritual education. Since 2002, ACA has welcomed International students and has seen a growth in this area of ministry.

If you have any questions after reading through the materials provided, please do not hesitate to contact us and we will do all we can to help.

May God richly bless you as you seek His will in making this important decision.

Sincerely,

Miriam Miller
International Program Coordinator


By signing this agreement, you are agreeing to abide by the conditions in the homestay agreement.

 

__________________

Date

 

_________________________              _____________________________

Host Father’s Name Printed                     Host Mother’s Name Printed

 

__________________________            _____________________________

Host Father’s Signature                            Host Mother’s Signature

 

 

INTERNATIONAL PROGRAM

HOMESTAY APPLICATION FORM

 

HOST PARENTS 

Address _______________________________________________________     

City ___________________________________________________________    

Postal Code ______________________________  

Home Phone ___________________________

Fax ___________________________________

Father                                                             Mother

First Name ____________________     First Name ______________________

Last Name _____________________    Last Name ______________________

Date of Birth _____/_____/_____          Date of Birth _____/_____/_____

Father’s work __________________     Mother’s work ___________________

¨Full time   ¨ Part time                  ¨Full time   ¨ Part time

Work Phone ____________________   Work Phone ______________________

Work Fax ______________________   Work Fax ________________________

Cell Phone _____________________    Cell Phone _______________________

Email _________________________   Email ____________________________

Church Affiliation _________________________________________________  

________________________________________________________________
 

CHILDREN, PARENTS, OTHER FAMILY MEMBERS  AND ANYONE ELSE LIVING IN YOUR HOUSE

First Name

Last Name

M/F

School currently attended, if any

Age

Living at home?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you do not have a child at home during the stay, will your student have opportunities to meet other children? Please provide any details.

________________________________________________________________________

 

Will there be other visitors staying in your home during the program? If yes, please list name and relationship.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________ 

 

HOME

What style home do you have? ______________________________________

(House - Mobile Home - Townhouse - Apartment/Condo - Farm House - or Other)

Number or bedrooms? ___________                            

Number of bathrooms in the house? ____________

Will the student have his/her own private bathroom? ______________________

Please describe your home and the surrounding area:

_________________________________________________________________

__________________________________________________________________  

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

 

How would your student get to school and how many minutes will it take?

Walking _____ minutes              

Driving ______ minutes          

City Bus ______ minutes

 

INTERESTS & ACTIVITIES

Indicate the activities (sports or hobbies) that your family is interested in and participates in regularly.

Sports                                                          Hobbies

___________________________                  ___________________________

___________________________                  ___________________________

___________________________                  ___________________________

___________________________                  ___________________________

 

PETS

Do you have any pets? If yes, how many?

Dog(s) Indoor ______

Dogs(s) Outdoor ______

Cat(s) Indoor _______

Cat(s) Outdoor _______     

Other _________________________

______________________________

______________________________

 

FAMILY WISHES TO HOST

Why do you want to be a homestay family for an international student? 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Prefer: ¨ Male ¨ Female

Would you be willing to host a student of the opposite gender that you requested?

____________________________________________________________________

Is your home ready for a student now? ____________________________________

____________________________________________________________________

ADDITIONAL INFORMATION

What aspects of your family life/community/area would you look forward to sharing with an international student? 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Can anyone in your family converse in another language? If yes, which language? 

_______________________________________________________________________

Have you ever hosted an international student before? If yes, when and how long? 

______________________________________________________________________

______________________________________________________________________

ALL HOMESTAY PARENTS ARE REQUIRED TO OBTAIN A CRIMINAL RECORD CHECK.


COMMENTS

Please feel free to share any additional information about your family that you feel would be helpful.

____________________________________________________________________

_______ ______________________________________________________________

________ ______________________________________________________________

________ ______________________________________________________________

________ ______________________________________________________________

________ ______________________________________________________________

 

REFERENCES

Please list two people who know your family very well. 

ACA and its staff will be the only people contacting your references.

 

Name: _____________________________________________________

Address: ____________________________________________________  

___________________________________________________________

Telephone: _______________________________

Relationship:____________________

 

Name: ____________________________________________________

Address: ___________________________________________________  

___________________________________________________________

Telephone: _______________________________

Relationship:____________________

   

OFFICE USE ONLY

Do you think this home would be a good homestay situation? 

Yes _______ No _______ Maybe __________

Callback Date:________________________________________

Date of homestay visit:________________________________

Criminal Record check received:    Yes _______  No _______