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Homestay Enquiry Form
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Items marked with an asterisk are required.
About You :
Title :
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Surname :
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Forenames :
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House Name / Number :
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Street :
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City / Town :
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County / District :
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Country :
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Telphone Number :
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Fax Number :
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E-mail Address :
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Date of Birth :
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<<--Click to pick date
Nationality :
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Language Skills :
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Mother tongue :
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Most Recent Education :
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--
school
college
university
for
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01
02
03
04
05
06
07
08
09
10+
years.
Knowledge of English :
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elementary
intermediate
advanced
About Your Stay :
I/We would like to stay for :
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1 week
2 weeks
3 weeks
4 weeks
5 weeks
6+ weeks
Desired arrival date :
*
<<--Click to pick date
Departure date :
*
<<--Click to pick date
Type of room required :
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private study/bedroom
shared study/bedroom
Smoker / non-smoker :
*
Choose one
Non-smoker
Smoker
Emergency Contact Name :
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- number :
*
Passport Number :
*
Hobbies and Interests :
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Special Requirements :
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Any other details :
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I accept the terms and conditions -
*
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Yes
No
*
Director of Ichthus House Homestay:
Reverend Colin Gibbs B.A.; Cert.Ed.; Cert. TEFL.
132 Bay View Road, Westward Ho!, Bideford, North Devon, England. EX39 1BJ
Telephone & Fax: +44 (0)1237 425348
