Ukrainian Refugees/Displaced Persons Hosting Form
This form allows us to understand more about you, and if you are able to take in Ukrainian refugees
Would you be willing to undergo a criminal record check?
Yes
No
Please understand that in order to host a refugee family, for their safety, it is necessary to undergo a criminal record check. If you are unable/unwilling to go through a criminal record check, we humbly ask that you support our cause by donating, via Interac Etranfer to UkraineKelowna@gmail.com, or by cheque payable to "Kelowna Stands With Ukraine" mailed to Suite #123 at 101-1865 Dilworth Dr, Kelowna, BC V1Y 9T1
What is your full name, and the full name of your spouse if applicable?
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
When can you start hosting?
-
Month
-
Day
Year
Date
How long can you host for?
How many bedrooms can you provide?
Is there a dedicated bathroom available for refugees?
Yes
Shared
Dedicated half-bathroom
Multiple dedicated bathrooms
Is there a dedicated kitchen for refugees?
Yes
No
Available partial kitchen
How many people do you have accommodation for?
What ages of children would you be willing to take in? If adults only, write N/A
What is your profession/source of income?
Do you have pets? If yes, please specify
Would you be willing to take families with pets
Yes
No
Is there a bus stop within close walking distance of your house?
Would you be willing to provide essential transportation for the family (job interviews, appointments)?
Yes
No
Have you and your family been vaccinated against Covid-19?
All fully vaccinated
All partially vaccinated
Some vaccinated some unvaccinated
Unvaccinated
Would the refugee family require vaccinations to stay at your house?
Yes (Will not host unless fully vaccinated before moving in)
Yes (Will require to get full vaccination dose upon arrival
It does not matter
Do you or any household members smoke?
Yes
No
Are you ok with hosting a smoking person?
Yes
No
Upload the pictures of accommodation if possible
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: