Farmstay/Ranchstay Application Form

Primary Contact Information

Title*

Student/Traveller Name*

Student/Traveller Date of Birth*

Email*

Phone*

Street Name and Number*

City*

Province*

Postal Code*

Nationality*

Native Language*

Program Start Date*

Program End Date*

Agency

Agency Name

Website

Phone

Fax

Contact Name

Personal Information

Do you smoke?*

If Yes, are you prepared not to smoke in the House?*

Interest and Hobbies? (Please select the three activities that occupy most of your Time)*

Do you have a driver's license?*

Shorty Essays

Please answer the following questions with complete sentences in the spaces below. Your answers to these questions will be read by our placement staff to help us determine the best possible placement for you, as well as by your prospective farm hosts once chosen, to give them a bit of an idea about you.

Why do you want to do farmstay in Canada?*

What do you expect to be your greatest challenge while doing farmstay?*

What do you expect to be your greatest reward while doing farmstay?*

Do you have any experience working on a farm or ranch, or doing related activities such as animal or care or agriculture?*

Describe your relationship with members of your family and friends.*

Describe any other special skills, abilities, education, or qualities that you think would be an asset while on the farm/ranch:*

Family Information

Name(1)*

Age(1)*

Occupation(1)*

Relationship(1)*

Name(2)

Age(2)

Occupation(2)

Relationship(2)

Name(3)

Age(3)

Occupation(3)

Relationship(3)

Name(4)

Age(4)

Occupation(4)

Relationship(4)

Name(5)

Age(5)

Occupation(5)

Relationship(5)

Other Information

Do you have any allergies? (If yes please specify)*

Do you have a special Diet? Eg. Vegetarian, lactose intolerant, etc.) (If yes please specify)*

Experiences:Describe any part time jobs or work experience you may have had.*

Have you ever lived outside your country? Yes (if yes, where?)*

Do you have any relatives or close friends in Canada? Yes (if yes, where?)*

Languages

Language(1)*

Years Studied(1)*

Proficiency(1)*

Language(2)

Years Studied(2)

Proficiency(2)

Language(3)

Years Studied(3)

Proficiency(3)

Travel Information

Airline

Flight Number

Arrival Date

Time of Arrival

am/pm

Arriving From

Pick-up Required?*

Drop-off Required?*

Letter to Host Family

Please write your prospective hosts a letter introducing yourself, explaining your motivations, and why you feel you will be asset while on placement with them. *

Terms and Conditions

I, understand and agree to release, hold harmless, and indemnify all StudyNet/Home-Sweet-Homestay (hereafter, HSH) owners, directors, officers, agents, employees, partners, and hosts, from any and all liability for loss, property damage, personal injury, or death, including any such liability that may arise out of any negligent act or omission which may be suffered or claimed by myself, my parent(s), or legal guardian(s) during, or as a result of, my enrollment in the HSH program.

Furthermore, I authorize the use of my name, voice, photograph, likeness, performance and/or biography by HSH in connection with any use of a product arising out of my participation in the HSH program. I authorize HSH to obtain and hold copyrights in such program and products, and to edit my performance and materials at its sole discretion.

I have read this Authorization, Indemnity, and Release Waiver of liability, and understand all its terms. I execute it voluntarily and with full knowledge of its significance, and accept to all its terms and conditions.

REFUND POLICY

In consideration of my acceptance and enrollment in the HSH program, I understand and agree to the following refund policies:

1. Placement fee(s) and/or Custodianship Letter fee(s) if applicable, are non-refundable.

2. Cancellations before program start date in Canada:

a) with 30 days or more notice:full refund less the Placement fee C$540

b) with less than 30 days notice:full refund less the Placement fee C$540 plus two (2) weeks stay fee C$252

3. Cancellations after program start date in Canada:

Full refund less the Placement fee C$540 and remaining stay fee for the current homestay session, plus two (2) weeks stay fee

4. Expulsion/Dismissal from the Program for reasons including, but not restricted to:breach of Canadian law, breach of HSH regulation:

Full refund less the Placement fee C$540 and remaining stay fee for the current session, plus one (1) full session stay fee, plus $200 processing fee

I confirm that I have read and agree to all the terms, conditions, and policies above.