Guest Application Form

Personal Details:

* Indicates required field

Name *

First

Last

Gender *

Date of Birth (e.g. 14 January 1985) *

Phone Number 1 *

Phone Number 2 *

Email *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Nationality *

Languages Spoken *

Level of English *

Religion (if any) *

Do you smoke? *

Do you have any special dietary requirements? *

Is there any food that you do NOT eat? *

Do you have any medical conditions or allergies? *

If yes, what is the condition/allergy? *

Homestay Request:

Where are you living now? *

Homestay arrival (e.g. 13 July 2016) *

Homestay Departure (e.g. 30 October 2016) *

Which homestay would you prefer? *

Homestay for under 18 year old: Price on application Short-stay (up to 2 weeks): Price on application No Meals: £104 pw Breakfast Only: £114 pw Breakfast & Evening Meal: £128 pw Breakfast, Packed Lunch & Evening Meal: £142 pw

Would you like a private bathroom (£13 extra pw) *

Please note, there is also a £75 booking fee

Would you like a homestay with children? *

Would you like a homestay with pets? *

About You:

Describe at least 5 of your hobbies/interests: *

Describe your personality (in at least 20 words) *

Describe your ideal host family *

Do you have any special needs/requests? *

What will you be doing in Swansea? *

If 'other', please give details: *

Provide address of study / workplace *

Provide name of course or work programme *

Emergency Contact Details

Name *

First

Last

Relationship to you *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

I understand that all information supplied is correct to my knowledge at the time of writing and any misinformation may result in the forfeit of the Homestay booking without refund of fees. *

Yes

I give permission to Swansea Homestay to contact me regarding services they can offer *

Yes

IMPORTANT MESSAGE FROM SWANSEA HOMESTAY:
You will hear back from us within 48 hours. If you do not then it is important that you check we have received your Application Form by emailing us on: info@swanseahomestay.com

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