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

 

Your First Name: ____________________ Your Last Name: ______________________

       

Title: ___ Mr. ___ Ms. ___ Mrs. ___ Miss.     Date of Birth: _____/_____/______

 

Nationality: _______________

 

Home Address: ________________________________________

 

                       ________________________________________

 

                       ________________________________________

 

Telephone Numbers

 

     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 ___

 

 

 

 

2. SCHEDULE INFORMATION

 

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: ____________________________

 

 

 

 

4. PAYMENT

 

  • Credit Card only

 

  • Advance Payment is $350 ($250 for Placement Fee + $100 for Deposit): See Terms & Conditions attached or Pricing & Policy in our homepage for details.

 

 

Credit Card Number: __________________________________________

 

Name on Card: _______________________________

 

Expiration Date: _______/________

 

 


 

Terms and Conditions

 

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

 

 

____________________________________            ____  / ____  / ____

                    Signature                                          Date