Homestay Information Form

Name *
Name
Date of birth *
Date of birth
Permanent Address (home country) *
Permanent Address (home country)
Emergency Contact Information
Family contact member *
Family contact member
Ex. Father / Mother
Homestay preferences
Please answer your preferences with yes or no, and indicate additional info only if necessary.
General info
Basic Plan *
Breakfast and dinner
Full Plan *
Breakfast, lunch and dinner
Private Bathroom *
Do you like pets? *
Do you smoke? *
Family Characteristics
With children *
Young or Adults *
No preference *
Health information
Indicate any requirement
Allergies *
Special meals *
Special medications *
Travel information
Arrival date
Arrival date
Departure date
Departure date
Others
Indicate your hobbies, interests, etc to your future homestay family.