Homestay Registration Form | Live And Learn Spanish .Com

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Homestay

Last Name: First Name:

Length of stay:

weeks

Level of Spanish:

Written:

Conversation:

Do you have medical insurrance? yes no	Policy No.
Do you have any allergies? yes no	If yes, please list them:
Do you have any medical problems? yes no	If yes, please list them:
Do you have any food restrictions? yes no	If yes, please list them:
Do you smoke? yes no Mexico is a mostly a smoke free environment but you are permitted to smoke outdoors
Do you like pets? Dogs: yes no Cats: yes no
Could you live in a home with either a dog or cat? yes no many homes in Mexico have a cat or a dog.
If there is a choice would you prefer a family with: Small children Teenagers Adults only

AGREEMENT AND MEDICAL AUTHORIZATION

I the undersigned, an applicant for the homestay program, do waive and release claims against Live And Learn Spanish (LALS) for injury, loss, damage, accident, delay, or expense resulting from my participation in the program.

I also release them and agree to indemnity them with regard to any financial obligations or liabilities that I may personally incur or any damage or injury to the person or property of others that I may cause while participating in this program: I understand that LALS is not responsible for any injury or loss suffered by me during periods of independent travel or absence from the program.

If I become ill, injured or incapacitated, LALS, the host family or the local coordinators may take such actions as any of them considers necessary, including medical treatment for me and transporting me back to my country, at my own expense. I release them from all liability relating to such actions.

I understand that my participation at LALS and the homestay program may be terminated at the sole discretion of LALS without a refund of fees and that I may be sent home at my expense if I do not adhere to the rules, standards and instructions. I agree that Mexican law shall apply to this agreement and I agree to submit to the jurisdiction at Mexican law.

I agree to pay promptly all telephone bills charged by me to the host family phone.

I agree to a minimum stay of 1 week and advise the homestay coordinator at least 4 weeks before I plan to cancel or make change.

If the applicant is less than 21 years old, please have a parent co-sign below.