Brisbane Student Application

Personal Details

1. Given Name(required)
2. Family Name(required)
3. Nationality(required)
4. Date of Birth(required)
5. Gender
6. male female
7. Street Address
8. City
9. Country
10. Area/ZIp/Postcode
11. Phone
12. Email(valid email required)
13. Fax
14. Agency Name
15. Agency Branch
16. Counsellor's Name
17. Counsellor's Email(valid email required)
18. Do you smoke?
19. yes no
20. Will you live with a smoker?
21. yes no
22. Do you like young children?
23. yes no
24. Do you like older children?
25. yes no
26. Do you like animals?
27. yes no
28. Are you allergic to Animals?
29. yes no
30. Do you have any special dietry requirements?
31. Religion (optional)
32. Do you have any illness?

Course Details

1. Name of Educational Institution in Australia(required)
2. Education Institution: Campus Name / Location or Campus Address
3. Course Commencement Date(required)

Accomodation and Travel

1. Accommodation required from (date)
2. Accommodation required to (date)
3. Is an airport pick up required?
4. yes no
5. Flight No.
6. Airline
7. Time of Arrival
8. Tell me about yourself, your family and your interests
9. What kind of family would make you feel comfortable?
10. Type of accommodation required

Emergency Contact Details

1. Person in Australia
2. Name
3. Address
4. Telephone
5. Email(valid email required)
6. Overseas Parent or Guardian
7. Name(required)
8. Address(required)
9. Telephone(required)
10. Email(valid email required)

Accept Terms

1. Do you agree to abide by Australia’s Anti-Discrimination Law and Privacy Law. Please see below*.
2. I agree
3. Have you read and agreed to the Aussie Families Tariffs, Terms and Conditions. Please see below*.
4. Yes

 

cforms contact form by delicious:days

Insurance: This is a policy we recommend for travellers not on student visas:
www.educare-world.com

Please read the following terms and conditions

Australia’s Anti-Discrimination and Privacy Laws
Australia’s Anti-Discrimination Law http://www.lawlink.nsw.gov.au/adb
and Privacy Law http://www.privacy.gov.au

Aussie Families Tariffs, Terms and Conditions
Brisbane Student Tariffs, Terms and Conditions

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. TELEPHONE61 2 9301 0900 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 9301 0999 or post to
AUZZIE FAMILIES Homestay Care Pty Ltd
PO Box 112 Rose Bay NSW 2029 Australia