Personal Details

  • / / Pick a date.
  • Male   Female

Parent Details

Room Details

  • A - Single Bedroom (Small)
    B - Single Bedroom (Medium)
    C - Single Bedroom (Large)
    D - Twin Share Bedroom (Medium)
    E - Twin Share Bedroom (Large)


I, the above-named applicant, have read this application form in conjunction with the information sheet provided. I understand that this is a Fixed Terms (44 weeks) agreement and that the reservation payment will not be refunded if I cancel the booking at any time. I further agree to abide by the House Rules and regulations as attached and acknowledge that any breach by me of these Rules and Regulations may result in the termination of my stay without any refund of rental monies paid at the discretion of Palmerston House.

Palmerston House, 2/105 Palmerston Street, Carlton, Victoria 3053, Australia
Telephone : +61 3 98802038