Respite Request Form | Comox Valley International Student Program

Homestay Respite Request Form

Respite homestay arrangements must be approved by the CVISP prior to commencement. Complete this respite request form a minimum of ten (10) business days in advance of the respite drop off date. A homestay coordinator will receive your request and email an approval or denial.

Homestay Name*
First Last
Homestay Email*
Drop off Date at Respite*
Date Format: MM slash DD slash YYYY
Pick up Date from Respite*
Date Format: MM slash DD slash YYYY
Number of Student(s) Requiring Respite*
Student Name*
First Last
Student Name*
First Last
Have You Arranged a Respite Family?*
Respite Name*
First Last
Respite Phone*
Respite Email*
Respite Address
Street Address Address Line 2 City Province Postal Code
Respite Home Payment Agreement*
I agree to make payment of $30 per night ($60 for 2 students) of respite directly to the respite family at drop off of my student(s).
- I agree
Name
This field is for validation purposes and should be left unchanged.

Homestay Respite Request Form

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