San Diego Homestay - Providing the finest homestay program and services in California

Get the Flash Player to see this rotator.

San Diego Homestay
6117 Wolfstar Court, San Diego, California
Ph: 858-457-1322 - Fx: 858-452-0615

School and Program Name:	Start Date(MM/DD/YYYY):	End Date(MM/DD/YYYY):
First Name:	Family Name:	Date of Birth (MM/DD/YYYY):
Address:
City:	Country:	Postal Code:
Home Phone : (city code - country code - number)
Fax Number : (city code - country code - number)
Email Address*:
Emergency Name:	Emergency Number:
Arrival Date (MM/DD/YYYY):	Arrival Time:
Flight Number:	Airline:
Housing Information (Select all that apply)
Private bedroom (Breakfast and dinner included)
Shared bedroom (Breakfast and dinner included, subject to availability)
Rent a room in an American home (food not included)
Personal Information
Male	Female
Personality: Shy	Outgoing	Other
Do you smoke?:	Do you drink?:
Transportation: Public Transit	Rent a car	Purchase a car
Do you have any medical conditions that we should be aware of?:	Yes	No
If yes, please explain :
Can you tolerate pets?:	Yes	No
If yes, please explain :
Do you have any special requests?
Please read and sign below. Then fax this form to: 858-452-0615 OR Read and sign(type) your name in the below. Then press the "Submit Application" button By typing your name below you hereby certify that the forgoing is true and correct to the best of my knowledge and agree, to hold harmless San Diego Homestay, it's owners and agents, from any claim by me for loses, costs, expenses, damages or injuries to persons or property, whether direct or in direct, or consequential, arising in any way out of any housing arrangement made between myself or anyone representing me and San Diego Homestay, including any activity related to such housing arrangement or agreement.
Signature (Name)*:	Date:

Application