Guest / Student Application    
       
Application
Destination
Destination Country *
Applicant
Applicant First Name *
Applicant Last Name *
Gender *
Age *
Citizenship *
No to pet type
Will you smoke?
English level
Any allergies?
Any health condition?
Emergency Insurance?
What are your hobbies?
Photo
Applicant photo (.jpg format) *
 
Select File...
Contact
Contact Type *
Applicant Relative Friend
Agent School Other
Contact Email address *
 Email
Confirm Contact Email *
 
Contact Mobile # *
Contact Phone #
Contact Skype ID
School
Will applicant attend school or internship? *
School / Organization Name *
School Country *
School State *
School City *
School Address *
School Zip / Postal *
Homestay
Start Date *
End Date *
Reason of stay
Meal plan
Average Homestay Rates
Here is a link to help you research the average
monthly homestay rate by city in order to be able to
set your budget to get successful homestay offers.
Search Average Rates by City!
Your monthly budget
Diet restriction
Any Request?
Address
Country *
State / Province *
City / Town *
Street Address *
Zip / Postal Code
Emergency
Emergency Contact Name
Emergency Relationship
Emergency Email
 Email
Emergency Mobile
Emergency Phone
Companion
Will you have a homestay companion? *
Arrival
Arrival Time
Do you need pick-up? *
Agreement

I, (the applicant, participant, registrant, student, guest, agent, parent, guardian and/or representative), understand and acknowledge all possible risks related to participating in a homestay program and/or staying in someone's home. I agree to release and hold IHA International Homestay Agency (the agency), its entities, employees, agents, share holders, partners, subsidiaries, and representatives harmless, in part or whole, from all liabilities, damage, and/or loss claims. Including any claims that may arise as result of any injury, lose, and/or damage that may and/or may not arise, arose or would arise, as result of direct and/or indirect usage and/or purchase of the agency's homestay accommodation, search, placement, selection, application, listing, pick up, and/or all associated services.
Do you accept terms and conditions? *
Yes
* Required field(s)
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        05/27/2016