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San Francisco  Homestay Application Form

Important! To apply, please send us the following items:

  1. A Completed Application Form. It can be submitted by mail or on-line.

  2. A non-refundable homestay placement fee of $200.

    Payment can be made wire (please e-mail us for account information) or by money order / bank draft in U.S. Dollars, payable to:

    APEX Education Consultants
    1224 Notting Hill Dr.
    San Jose, CA 95131
    USA

Once we receive your payment, we will mail you your host information and a confirmation of placement.

1. Family Name:    First Name:  
2. Gender: Male  Female
3. Date of Birth (m/d/y):
4.  Address: 
                    City:    Country:
5. Telephone:   Fax:
7.E-mail:
8. Purpose of visit: Education-Name of School:
                             Other:
9. What is your arrival schedule?
                              Date:     Time:
                            Airline:   Flight #:
10. How long are you going to stay in SF?  
11. Do you have any allergies?
12. Do you smoke?    yes     no
13. Do you like pets?  yes     no
14. Area you comfortable to stay with a family with children? yes     no
15. Do you have any interests and hobbies? 
                                                                 
16. Accommodation Preference:
       
17.Additional questions:
    

                        AGREEMENT AND MEDICAL AUTHORIZATION
As a recipient of homestay placement services, you agree to obey all laws and regulations of the United States and the State of California, where your homestay  is located. You agree to pay monthly room and board costs or room cost to your host family in the full amount you agreed to.
You agree to provide medical insurance that is adequate to cover any medical costs incurred while in a homestay placement provided by this placement service.

YOU ACKNOWLEDGE THAT THE HOST FAMILY MAY DECIDE ON EMERGENCY MEDICAL TREATMENT FOR YOU, INCLUDING SURGERY, AND RELEASE THEM FROM ALL LIABILITY RELATED TO SUCH ACTIONS.

I have read, fully understand, and agree to the terms and conditions of this agreement.

Please check this box to indicate signed approval:   Date:

                                                    

For more details please contact:

APEX School Search USA
Education Consultants
E-Mail: info
USA Fax: (240) 214-5648


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January 2000
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