Arrival Flight #s:
Departure Flight #'s:
Date of Arrival:
Date of Departure:
Flight Times (Arrival):
Flight Times (Departure):
Airport service required: Yes____ No ____
Length of stay: 1 month ____ 3 months ____ other ____
Name of School you will be attending in Calgary:
Name of Health Care Insurer:
List your interests and hobbies:
Do you like pets: Yes ___ No___ Maybe___
Are you a smoker? Yes ___ No ___
Do you have any food allergies or require a special diet?
No ____ Yes____ (please list)
Do you like children: Yes ____ No ____
How strong is your English: weak ___ good ___ excellent ___
Have you ever been charged with an offence? If so, what was it?
Will you require any type of medication for illness during your stay? If so, what kind?
Do you agree to follow and respect all host family house rules while in their home? Yes ____ No ____