ATTENTION: Before completing this form, please read Homestay Payment Procedure and Refund Policy carefully and thoroughly.

 
Personal Information
(All information will be kept confidential. For more info see our privacy policy)
 * First name
 * Last name
 * Street Address
 * City
 State in the U.S.
  State or region outside of the U.S.
 * Country
 Zip code
 * Phone number
 Country code
  area code
  prefix
  suffix
 cell number
 Country code
  area code
  prefix
  suffix
 * Email address
 * confirm email address
 * Gender
 * Date of birth

* Place of Birth
 Passport #
  * Passport valid until
* Nationality (citizenship)
 Religion
 * Emergency contact person
*  Relationship
 * Phone number      
 Country code
  area code
  prefix
 suffix
 
  Homestay Information
(For detailed info about our host families, see Host Family and FAQ)
* Please select which service you would like to choose:
Homestay Only
Tour Package
* Your homestay destination ( Please hold Ctrl for multiple selection )

* Please select your desired price range:

* Number of guests
 * Languages you can speak

* Arrival date
 Length of Stay

* Airport pick up? (US$35 per order) Yes No

* Do you smoke? Yes No
 
* Do you mind a family with a preschool-age child ? Yes No
 

* Do you mind a family with pets? Yes No
 

* Are you interested and qualified to apply for our Free Homestay Package?(Please note that these spaces are limited, and are first come, first served)
Yes No
 

* If a free homestay is not available, would you still be willing to join our program?
Yes No
 

Please list any allergies, health problems, or foods that you can not eat.

Please indicate a few of your hobbies or special interests. We will try to match these with a host family

Use the space provided below for any additional detail about yourself. Also, please specify if you have a preferred family after searching our database

How did you hear about Lotus?
Please specify

 
TERMS AND CONDITIONS
By initialing below, I agree that I have read the program information, understand and accept the conditions under which these programs will be conducted, particularly those which apply to the homestay fee and refund policy. I understand that the program cost includes administrative expenses, and hereby release Lotus, their agents, employees or representatives from all actions suits, claims, or liability for damages arising out of my participation in the program. I confirm that I have also read the "Notice of Understanding Between Participant and Lotus"
Please type initial here
 
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Copyright ©2002-2005 Lotus Educational Foundation All rights reserved
Lotus Educational Foundation
1173 South De Anza Blvd. Suite D
San Jose, CA 95129, USA
Tel: (408) 996 1929
Email: inquiry@homestay.com.cn