First name*
Last name*
Gender* MaleFemale
Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Date of birth
Visa satus* StudentWorking holidayVisitor
Email*
Name of School
School Starting Date
School Term (Weeks)
Do you like children? YesNo
Do you smoke? YesNo
Do you have any allergy? YesNo
Do you like pets? YesNo
Any request for your homestay?
Arrival date
Flight No. / Arrival Time
How long are you planning to stay in homestay?*
Any request for your room?
How long are you planning to stay in the room?*
