London Host Families

Reservation Form

Please fill out the application form and click on the submit-button in order to send it by email.You can also print it out and fax it or send it by traditional mail. London Host Families - 1, Harrington Road, London, SW7 3ES tel : 0207 589 2929 fax : 0207 589 2989

e-mail : info@londonhostfamilies.com

Sending this reservation form does not oblige you to complete the booking. We will respond as soon as possible with details on a proposed accommodation before you send payment.

PERSONAL INFORMATION
Name
Surname
Email Address
Sex	Male Female
ID Card N°
Date of birth	dd/mm/yyyy
Address
Town
Post Code
Tel
Fax
Nationality
N° of persons	Adults Children
ACCOMMODATION REQUIRED
Single Room Double Room Twin Room 1st Choice 2nd Choice Room only Breakfast only Breakfast and Eve Meal Special Requirements :	Student * Work Placement * * If you are a student or on work placement you must give your school or company name and address below: Smoker Non-Smoker Are you allergic to anything (animals, food etc - confirmed allergies only please) : Do you have a medical condition? If so please specify:
LANGUAGE COURSE/SCHOOL (if required)
Course required (Optional)	from to dd/mm/yyyy hours per week :
Duration of stay	from to dd/mm/yyyy
Arrival time (nb without precise arrival information we cannot organise for someone to wait at your family accommodation for you)	At eg. Airport Time

How did you hear about us : Please specify:

DATE: dd/mm/yyyy Declaration: I/We have read and understood and agree to the terms and conditions/general agreement.

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