C3 Canadian Cross Training Club 104 Maple Avenue, Inglewood, On., L0N 1K0 phone:(905) 838-2662 fax:(905) 838-0220 www.c3online.ca Homestay Form for Hosts HSBC ITU PAN AMERICAN CUP TRIATHLON FESTIVAL July 26 to July 30, 2005 PRINT THIS FORM FILL IT OUT AND FAX TO: 905-857-4566 ATTN:Darryl MacArthur

Yes! I would like to host a visiting athlete!

Host name:____________________________________________________________________________

Host address:__________________________________________________________________________

Host phone number:___________________________ Host e-mail:________________________________

Number of adults in host family home:_______

Number of children and ages: _____________________________________________________________

I am able to accommodate ______ athlete(s) (indicate maximum number you can comfortably host).

Bed(s) available (indicate number and size):__________________________________________________

Do you have pets?________ If Yes, what type of animal:________________________________________

Does anyone in your home smoke?__________

Does anyone in your home have an allergy that a guest must be aware of?__________________________

If yes, to what?:______________________________

Would you prefer to host a: male athlete:_______ female athlete: ________doesn’t matter:_____________

Does anyone in your home speak a language other than English?: Specify:__________________________

What is the earliest date the athlete is welcome to arrive?:_______________________________

What is the latest date the athlete is welcome to stay until?:_______________________________________

Do you have any other comments or concerns?_________________________________________________

 For more details, visit www.c3online.ca

Thank you for being a friend of C3 and the visiting athletes.
All the information collected on this form is solely for the purpose of helping us match families and athletes.
This information will be kept confidential to C3, and not sold or otherwise distributed.