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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 $350 ($250 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 customers who want to study in Seattle and Washington state area with a premier housing placement service.

  • 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.

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

  • Airport pick-up service will be performed by the host family or the agent of Seattle Homestay upon arrival at the airport.

  • 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 $350 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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