Brisbane Student/Visitor Application

Brisbane Student

Personal Details

DD/MM/YYYY
E.g. Gluten free, coeliac, lactose intolerant, vegetarian/vegan, religious/cultural exclusions (no pork/beef)
Illnesses e.g. asthma, diabetes, epilepsy, heart disease or other. Allergies e.g. foods/pets

Course Details

DD/MM/YYYY

Accomodation and Travel

DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY

Parent Contact Details – all of this is compulsory

Emergency Contact Details Person in Australia

Emergency Contact Details Overseas

Parent Contact Details Person in Australia

Accept Terms

Student requests are seriously considered but it may be not be possible to meet all requests. Additional requests cannot be considered after placement confirmation or additional charges apply.

Email confirmation

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

Payment Options

1. TELEGRAPHIC TRANSFER: payable to AUZZIE FAMILIES Homestay Care (Bank details upon application – please refer to instructions provided with your invoice) Please be sure to include the invoice number and student name as reference.

2. BANK DRAFT / BANK CHEQUE: Payable to AUZZIE FAMILIES Homestay Care

3. TELEPHONE: 61 2 9301 0900 and quote your credit card details (MasterCard / 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 / VISA ……………….

SIGNATURE:……………………………….

NAME ON CARD:…………………………….

EXPIRY DATE:…………………………….

AMOUNT $……………………………………

Please print this page and fax to 61 2 9301 0999 or post to:

AUZZIE FAMILIES Homestay Care
PO Box 1219 Eastwood NSW 2122 Australia

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