Study Tour Homestay

Family Name *

First Name *

Date of Birth *

Nationality *

Gender *

Please upload your recent photo - No Photo ID(i.e passport) please *

Click or drag files to this area to upload. You can upload up to 2 files.

Mobile *

Email *

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 okay with pet animals? *

Self-introduction *

Parent's name *

Relation *

Age *

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.