Brisbane Homestay Services
Brisbane Homestay Services

ACCOMMODATION

Homestay Host

Accommodation Application Form

We MUST receive this form at least 2 weeks before you arrive in Brisbane.

Please press "submit" when completed, or print this form and fax it to +617 32897900.

The information I have supplied in this form is true and correct.

I have read and understand the homestay conditions and terms.

 

COURSE DETAILS
Name of School:
Name of Course:
Student Number:
Length of Course:
Start Date:
PERSONAL DETAILS
Family Name: * required
First Name: *
Prefered Name:
Email: *
Home Address:
Country:
Phone:
Fax:
Date of Birth:
Sex:
Marital Status:
Your Nationality:
Religion:

 

YOUR FAMILY DETAILS
Father:
Mother:
Brothers:

Age:

Age:

Sisters:

Age:

Age:

Father's Occupation:
Mother's Occupation:
Date arriving in Australia:

 

YOUR ACCOMMODATION REQUIREMENTS
Which type of accommodation do you require:

Homestay
Apartment
House
Share House
Hotel

If not homestay, how many bedrooms do you require?

How long do you intend to stay in homestay accommodation?(Eg. 4 weeks, 1 semester or length of course):

Do you have any objections to pet dogs?
Yes
No
Are you a vegetarian?
Yes
No
Do you have any objections to pet cats?
Yes
No
Do you smoke?
Yes
No
Do you have any objections to young children?
Yes
No
 
Do you take any medications? Yes, details:
No
Do you have any allergies? Yes, details:
No
Do you have any dietary restrictions? Yes, details:
No
List your hobbies and special interests:
Please describe any other special requirements:
Do you require airport reception on arrival? Yes
No
ENGLISH
What is your level of English?

 

AGENT DETAILS

Company:
Contact Person:
Phone:
Fax:
Email:

 

EMERGENCY CONTACT DETAILS

Name:
Address:
Phone:
Relationship to student:
Message:

Please press "Submit Application" or print and fax this form to +617 32897900.


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