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English
Deutsch
(
German
)
Português
(
Portuguese (Brazil)
)
日本語
(
Japanese
)
Español
(
Spanish
)
Programs
Homestay
Teacher Stays
Executive Stays
Farm stay & Ranch stay
Students
Why HSH?
The HSH Experience
Evaluate
FAQ
Student Application Form
Payment
Families
Why HSH?
The HSH Experience
FAQ
Homestay Application Form
Farm/Ranch Application Form
Schools
WHY HSH?
FAQ
Get in Touch
Registration Referral Form
Payment
Agents
Why HSH?
FAQ
Get in Touch
Registration Referral Form
Payment
Cities
Vancouver
Victoria
Montreal
Calgary
Edmonton
Toronto
Windsor
Ottawa
About Us
Blog
Contact Us
Registration Referral Form – Agents
Agency
Agency Name
*
Counselor Name
*
Agency Email
*
Agency Phone
*
Agency Street Address
*
Agency City
*
Agency Country
*
Student Information
Title
*
---
Mr.
Ms.
First Name
*
Last Name
*
Date of Birth
*
Nationality
*
Native Language
*
Phone
Email
*
Homestay Preference
Check In
*
Check Out
*
Cats
*
---
Yes
No
No Preference
Dogs
*
---
Yes
No
No Preference
Kids
*
---
Yes
No
No Preference
Smoking
*
---
Yes
No
Program
*
---
Homestay Single Room
Homestay Shared Room
Teacher Stay
Executive Stay
Ranchstay/Farmstay
Furnished Apartment
Meal Plan
*
---
Full Board (3 meals/day)
Half Board (Breakfast and Dinner)
B & B (Breakfast Only)
Roomstay (No Meals)
Other Information
English Level
*
---
Beginner
Intermediate
Advanced
Do You Smoke?
*
---
Yes
No
Medical Conditions? (Specify)
Allergies? (Specify)
Food Restrictions? (Specify)
List Your Favorite Activities, Hobbies & Interests
School Information
City Destination
*
---
Vancouver
Victoria
Montreal
Ottawa
Calgary
Edmonton
Toronto
Windsor
School Name
School Start Date
School End Date
Travel Information
Airline
Flight Number
Arrival Date
Time of Arrival
am/pm
---
am
pm
Arriving From
Pick-up Required?
*
---
Yes
No
Drop-off Required?
*
---
Yes
No
Custodianship Request
Applicants under 19 years of age only
*
---
NO - this applicant does not require Custodianship/another Custodian has already been arranged on behalf of this applicant
YES - please arrange the custodianship on behalf of this applicant
Parent 1
First Name
Last Name
Date of Birth
Telephone
Street Address
City
State/Province
Country
Parent 2
First Name
Last Name
Date of Birth
Telephone
Street Address
City
State/Province
Country
Notes
Other Information