HOST FAMILY

NOTE : The rent is from €900/month (included electricity, Internet and agency fees)

What is the purpose of your trip?
 Student Job Internship French Other

In which school/company are you ?

Check in (yyyy-mm-dd)

Check out (yyyy-mm-dd)

 Smoking Non-Smoking

 Animals accepted Animals not accepted

What is your French level?
 Beginner Intermediate Good Excellent

 Standard category Superior category (private bathroom)

Which formula would you like?
Single room + breakfastSingle room + 3 dinnersSingle room + 5 dinnersSingle room + half-boardShared room + breakfastShared room + 3 dinnersShared room + 5 dinnersShared room + half-board

Please let us know your hobbies and any allergies, dietary requirements, or medical conditions

------About you-----

Name

Surname

Email Address

Nationality

Date of Birth (yyyy-mm-dd)

 Male Female

Your Full Home Address

Email of the person to contact in case of emergency

Phone of the person to contact in case of emergency

Name and surname of the person paying for the order