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Agency Name :
Applicant Name (required):
D.O.B (Date of birth):
Your Email (required):
Address (House # / Street Name / City / Prov. / Postal Code):
Name of the school:
VisitorStudy PermitWork Permit (Working Holiday)
Young Children No young Children Teenagers No teenagers Adult Only Other students No preference
Do you like pets?
None Dogs Cats Other
Are you a smoker?
Do you drink?
2 Meals 3 Meals None
What are the foods you cannot eat?
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Copy of your e-Ticket (Max. 2 MB)
I (We) confirm the accuracy of all information enclosed in the Homestay Request Form.