Nanaimo Buccaneers Prospects Camp April 19-21 at Nanaimo Ice Centre sign up today!!

Host Family Application

Applicant Name:
Applicant Age:

Spouse Name:
Spouse Age:

Address:
City:
Postal Code:

Email Address:
Home Phone:
Cell Phone:
Work Phone:

Do you have children at home?
If yes:
Child 1 Age: M or F:
Child 2 Age: M or F:
Child 3 Age: M or F:

Do you or your spouse work from home?
Applicant Occupation: Applicant Employer:
Spouse Occupation: Spouse Employer:

Do you have pets?
If yes please list:
Pet 1
Pet 2
Pet 3

Do you have internet access?

Have you ever hosted before?

Is your home smoke free?

How many players are you interested in hosting?

Are you interested in helping if a short term host situation is required?

Tell us why you would like to Host a Buccaneer:

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