Please fill in the following form. We will put you on our student list and messages from families will get sent to you by email.

All of your information is kept private. Email addresses are not displayed in public searches.

Student name:
Gender:	male female
Email address:
Select a password: (8 char min)
Please confirm:
Home city:
Home country:
Region (ie. state or province):

Destination country:	Canada
Destination region:	Ontario
Destination city:	Ottawa (including surrounding area)
Which school will you attend?

Arrival date:	year month day
Departure date:	year month day

How much are you willing to spend?	$ Canadian (numbers only, no commas or symbols)
Should this include meals?	yes no
(if yes) breakfast	yes no
(if yes) lunch	yes no
(if yes) dinner	yes no

Do you smoke?	yes no
Do you mind pets?	yes no

What would you like to accomplish during your visit?

Please introduce yourself to your homestay family:

Today's date: 2010-07-29