HARTPURY ACCOMMODATION

Your trusted local alternative to on-campus living

Students Birth Name

First

Last

(as shown on passport)

Students Date of Birth

Students Email Address

Confirm Email

Students Phone Number

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Students given Nationality

Students Gender

Does the student drive or have access to a car?

Is the student likely to be returning home at the weekends?

What Course are they studying?

Does the student have any medical conditions?

Does the student take any regular prescribed medication?

Any behavioural, emotional or social difficulties?

Any allergies?

Students favourite foods

Students hobbies and interests

Students personality

Emegency Contact Name

First

Last

Relationship to Student

Emergency Contact Email

Phone

Payment Section

Emergency Gender Birth

Hartpury Accommodation Registration

Price: £150.00

To confirm a place.

Stripe Credit Card

Total

£0.00

Contract Section

Checkboxes

I have read and agree to the Hartpury Homestay Contract

Parents Name

First

Last

Signature

Clear Signature