Applicant's Last Name*
Applicant's First Name*
Home Phone *
Cell Phone*
Main Email*
Alternate Email
Alternate Cell Phone
Work Phone
Street Name and Number*
City*
Province*
Postal Code*
Skype/Google Hangout/Other
Preferred Contact Method*—Please choose an option—TelephoneEmail
Applicant's 1st Name*
Birth Date (1)*
Relationship (1)*—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (1)*
First Name (2)
Birth Date (2)
Relationship (2)—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (2)
First Name (3)
Birth Date (3)
Relationship (3)—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (3)
First Name (4)
Birth Date (4)
Relationship (4)—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (4)
First Name (5)
Birth Date (5)
Relationship (5)—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (5)
First Name (6)
Birth Date (6)
Relationship (6)—Please choose an option—MotherFatherSonDaughterGrandmotherGrandfatherNephewNieceCousinFriendSon-in-lawDaughter-in-lawFianceeOther
Occupation (6)
Participant age preference*—Please choose an option—No PreferenceYouth (19 - 24 yrs)Mature (25 yrs +)
Or: Only Within This Age Range (Specify)
Will You Host a Smoker?*—Please choose an option—YesNoOutside Only
What Participant Gender(s) Can You Host?*—Please choose an option—MaleFemaleNo Preference
Can You Host Family Groups ?*—Please choose an option—YesNo
Other Comments
Home Type*—Please choose an option—FarmRanch
Total # bedrooms for volunteers*—Please choose an option—1234
How far is the Nearest City/Town?*
Specify city/town name*
Is volunteer's room*—Please choose an option—PrivateSharedChoice
Is volunteer's room in:*—Please choose an option—Main homeSeparate cabinTrailerTent
Please Choose All That Apply (Keep CTRL Keyboard Button Pressed to Select Multiple Options)*—Please choose an option—Horses (breeding)Horses (riding)Cows (dairy)Cattle (Beef)SheepGoatsPigsChickensTurkeysDucksBisonLlamasBeesFood ProductionTextile/other ProductionTourismBoardingGeneral AgricultureHayingFlower productionFruit/OrchardVineyardBerriesGreenhouse/NurseryVeterinaryAnimal Rescue
Do You Have Any indoor Pets?*—Please choose an option—0123
Type of Pets:*—Please choose an option—N/ADogCatOther
Does Anyone in Your Home Smoke?*—Please choose an option—YesNoOutside Only
List Your Favorite Activities, Hobbies & Interests:*
List Language(s) Spoken In Your Home*
Have You Ever Hosted An International Volunteer Before?*—Please choose an option—YesNo
If Yes:
a) Since What Year?
b) For How Many Years (Cumulatively)?
c) From What Country(ies)?
d) From What Agency(ies)?
Can You Accommodate Participants with Special Diet (e.g. Kosher, Halal, Vegetarian, Allergies)?*—Please choose an option—YesNo
How large is your property (acres):
Please describe some of the chores and responsibilities your volunteer would be doing:
Do You Have a Current CRC?*—Please choose an option—YesNoPending
If Yes, When Was This Done?
Do All Other Family Members 18 Years and Older Also Have a Current CRC?*—Please choose an option—YesNoPending
Do you currently have availability to host a volunteer?*—Please choose an option—YesNo
Please specify the months of the year you are generally available to host:
Are you currently hosting any other volunteer?—Please choose an option—YesNo
If yes, from what country(ies)?
If you have room(s) becoming available in the near future, please specify date(s)
How did you find out about Home-Sweet-Homestay Canada?*
Please Add Any Comments About Your Ranch/Farm That You Think Would Be Important For Participants/HSH to Know
