Study Tour Homestay

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Family Name

First Name

Date of Birth

Nationality

Gender

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Mobile

Home Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Language you speak

Religion

Study Tour Start Date

Study Tour end date

Do you smoke?

Do you have any medical condition/s?

Do you have any allergy?

Do you have any special dietary requirements?

Are you comfortable with pets?

Self-introduction

Parent's name

Relation

Parent's Email

Any other family members living in your house?

Name of Institution Attending

Declaration of Happy Homestay Adelaide Fees and Conditions:

I confirm that the information given in this form is true, complete, and accurate.
I hereby give Happy Homestay Adelaide permission to collect, use and disclose relevant information about the student for the purpose of the student’s homestay arrangement.