Personal Details Male or Female * Male Female Nationality * Age * Religion Telephone * Mobile Email Your Home Country Address * Passport Number * Emergency Contact Full Name * Phone * Email Relationship to you Health Conditions
Do you have any allergies/medical conditions we need to know about? (if yes, please provide details below) All information supplied is confidential
Please provide the full UK address including postcode of your place of study or work. This will help us find the best location for your homestay.
Booking Information Level of English Beginner Intermediate Advance Duration of Homestay How many single rooms? * How many twin rooms? * Accommodation Type * SC - No meals, cook and prepare your own meals BB - Bed & Continental Breakfast HB - Bed & Continental Breakfast & Evening Meal FB - Bed & Continental Breakfast, Packed Lunch & Evening Meal Do you have any special dietry requirements, (dairy-free, gluten-free, halal, kosher, nut-free etc)? * If yes, please provide further information Do you have food allergies? * Would you be happy to be placed with a homestay host that may have the following? Another student speaking your first language? * Flight Details Flight Number Arrival UK Arrival Airport/Terminal UK Do you reqiure transfer? * Yes No Do you reqiure transfer? * Yes No If you are travelling with someone else please put their full name below How did you hear about Stella Homestay Services? * Search Engine (google, Yahoo etc) Recommended by friend Social Media Other DATA PROTECTION STATEMENT – Stella Homestay Services respect your privacy, and the personal information supplied here is protected under the Data Protection Act. We will not disclose this information to any third parties other than to the potential host, college, university and any authorised inspectors/regulatory bodies without your prior consent. You are entitled to demand access to any information referring to you. *