One of many Auzzie Families homes

Click here for a print version

Please fill in this form so that we can help find the most suitable accommodation for you. If you wish you can print the form
and post or fax it to us.
In order to commence work on your placement the signed application form and the CONFIRMATION BOOKING FEE (placement Fee + 4 weeks homestay + airport pickup + guardian fees for one month) is required. 

Given Name

Family Name

Your Nationality Date of Birth
Gender: Female Male
Street Address
City
Country
Area / Zip / Post Code
Phone Number:
Fax :
Email :
Agents Name and Phone:
Do you smoke?
yes no
Will you live with a smoker?
yes no
Do you like young children?
yes no
Do you like older children?
yes no
Do you like animals?
yes no
Are you allergic to Animals?
yes no
Do you have any special dietry requirements?
Religion
(optional)
Do you have any illness?
Name of Educational Institution in Australia & address ( if relevent )
Accommodation required from (date) to
Is an airport pick up required? yes no
Flight No. Airline Time of Arrival
Tell me about yourself, your family and your interests
What kind of family would make you feel comfortable?
Type of accommodation required
Emergency Contact Details
Person in Austrlia
Name
Telephone
Email
Address
Person Overseas
Name
Telephone
Email
Address
PAYMENT OPTIONS Click here for a print version 
1. TELEGRAPHIC TRANSFER payable to AUZZIE FAMILIES Homestay Care Pty Ltd No2 A/C (Bank details upon application)
2. BANK DRAFT Payable to AUZZIE FAMILIES Homestay Care Pty Ltd No 2 A/C
3. TELEPHONE 61 2 9365 4898 and quote your credit card details MasterCard / Bankcard / Visa
4. DIRECT CREDIT CARD CHARGE fill out the authority below and return it to our address (Note a 4.5% surcharge applies to all credit card transactions. Please add this amount to your total payment.)
CARD NUMBER................................................................................................
TYPE OF CARD MasterCard.........BANKCARD........VISA...................

SIGNATURE.....................................

NAME ON CARD..................................
EXPIRY DATE..................................

AMOUNT $..........................................
5. CHEQUE payable to AUZZIE FAMILIES Homestay Care Pty Ltd

Please print this page and fax to 61 2 9130 8680 or post to
AUZZIE FAMILIES Homestay Care Pty Ltd 58 Nancy Street, North Bondi. NSW 2026 Australia
© AUZZIE FAMILIES Homestay Care Pty Ltd