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Application for Homestay

Thank you for your interest in taking a Homestay with Seattle Homestay. If you would like to apply for the homestay, please complete the online form below. Before you send this form after completion, please read our Terms & Conditions carefully. You can also print this form , fill out and fax or mail it to us.

Fax Number:  1-253-835-4341
Address: Seattle HomeStay
P.O. Box 25615
Federal Way, WA 98093-2615   USA

1. PERSONAL INFORMATION

Title

MM DD YYYY
Birthday
 

Name


First

Last
 

Nationality 

Address


Street1

City

State/Country

Zip/Postal Code

Telephone


Home

Work

Cell

Fax

Email

Level of English

Do you smoke?

 Yes   No

Families with pets?

 Yes   No   No Preference 

Do you have any allergies?

 Yes   No
If Yes, please specify?  

 Families with small children?

 Yes   No    No Preference 

 Are you bringing your notebook computer?

 Yes    No 
 
2. SCHEDULE INFORMATION

College Name Attended

MM DD YYYY
Starting of Class

Periods of Staying

Year(s) Month(s)

HomeStay Duration

MM DD YYYY
Starting Date
MM DD YYYY
Estimated Ending Date
 

Date of Arrival in Seattle

MM DD YYYY

Airline

Flight Number
 
3. EMERGENCY CONTACT

Name of Emergency Contact

Relationship of Contact Person

Telephone

Email

 
4. PAYMENT
  • Payment Method: Credit Card, Money Order, Traveler's Check & Personal Check
  • Advance Payment is $375 ($275 for Placement Fee + $100 for Deposit): See Terms & Conditions attached or Pricing & Policy in our homepage for details.

Card Number

 

Card Type

Name on Card

Exp. Date

Month / Year
 
Terms and Conditions
  • Seattle Homestay provides the international students who want to study in Seattle and Washington state area with a premier housing placement service.

  • A $275 Placement Fee for homestay and a $100 Deposit must be paid with a credit card at the time of homestay application. The $100 Deposit is to be paid to the host family as a part of homestay fee upon arrival.

  • Detailed pricing on homestay fee and placement fee, and refund policy will comply with the guidelines described on Pricing & Policy.

  • Airport pick-up is provided by host family based on availability, and the fee for airport pick-up is $50. This fee must be paid to host family along with first homestay fee. In case pick-up is not available by host family, Seattle Homestay will provide international students with detail information on public transportation. 

  • Seattle Homestay shall provide the customer with detailed information about host family through e-mail or fax at least 1 week before arrival.

  • Seattle Homestay is not liable for any damages or loss caused by the host family or the students.
IMPORTANT! By checking checkbox below, I certify that I have read and understood the terms and conditions of Homestay, and I do hereby authorize Seattle Homestay to charge $375 to the above credit card account for homestay placement services.
I have read and understood the terms and conditions stated above.
 

Full Name in English
MM DD YYYY
Date Completed This Form
 
 
 P.O. Box 25615  Federal Way, WA  98093-2615  |  Phone: (253) 835-4337  |  Fax: (253) 835-4341  |  E-mail: info@seattlehomestay.net
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