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
1. PERSONAL INFORMATION
Your First Name: ____________________ Your Last Name: ______________________
Title: ___ Mr. ___ Ms. ___ Mrs. ___ Miss. Date of Birth: _____/_____/______
Home Address: ________________________________________
Home: ___________________ Work: ____________________ H/P: _____________________
Fax Number: _________________ Email Address: ________________________
Level of English: ___ Low ___ Medium ___ High
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 ___
College Name Attended: __________________________ Starting Date of Class:____/____/_____
Periods of Staying: ___ Year(s) ____ Month(s)
Starting Date of Homestay: ____/_____/_____
Estimated Ending Date of Homestay: ____/____/_____
Date of Arrival in Seattle: ____/____/_____ Airline: ______________ Flight Number: _________
3. EMERGENCY CONTACT
Name of Emergency Contact: _______________________
Relationship of Contact Person: _____________________
Telephone Number: ________________________ Email Address: ____________________________
Credit Card Number: __________________________________________
Name on Card: _______________________________
Expiration Date: _______/________
q Seattle Homestay provides the international customers who want to study in Seattle and Washington state area with a premier housing placement service.
q A $250 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.
q Detailed pricing on homestay fee and placement fee and refund policy will comply with the guidelines described on Pricing & Policy.
q Airport pick-up service will be performed by the host family or the agent of Seattle Homestay upon arrival at the airport.
q In case the homestay place is out of Seattle & Tacoma area, the customer must set up the nearest airport in advance via SeaTac airport on his/her ticket. For example, Spokane (GEG), Pullman (PUW), Port Angeles (CLM), Yakima (YKM). And if the customer wants a bus shuttle service instead of the air service, and informs the Seattle Homestay in advance, Seattle Homestay must provide the bus schedule for the customer.
q Seattle Homestay shall provide the customer with detailed information about host family through e-mail or fax at least 2 weeks before arrival.
q Seattle Homestay is not liable for any damages or loss caused by the host family or the students.
By signing below, I certify that I have read and understood the terms and conditions of Homestay, and I do hereby authorize Seattle Homestay to charge $350 to the above credit card account for homestay placement services.
Full Name in English
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