Host Family Application Form

    Captionless Image

    Why Host?

    The 2016 Japan-America Grassroots Summit in Greater Atlanta, Georgia ・日米草の根交流サミット2016広域アトランタ大会 gives Japanese individuals the opportunity to become acquainted with local families in the greater-Atlanta area. The Host Family Program pairs these individuals with families who welcome them to the U.S. and help them adjust to life in greater-Atlanta. Why Host? • The chance to help an interested individual experience life in another country and culture. They will have many questions for you and expect to get questions in return. • The chance to gain an international friend. You will share many experiences over the three nights and make memories to last a life time. • The chance to let your children to learn and grow. What do we do? Host Families Should: • Provide 3 nights of lodging and meals (October 6th-8th) in their homes for the Japanese guests. Guests are prepared to pay their own share for any meals eaten outside of the home, as well as other local activities. • Provide transportation for the guests while they stay with host families in the local community October 6th – October 9th as well as provide transportation to Atlanta on October 9th for the closing ceremony. Hosts are also invited to the closing ceremony. If transportation to/from Atlanta is an issue, please contact JASG for help. • Share/exchange information about each other’s culture. Experiencing everyday life in someone’s home in a foreign country is the purpose of this program. Keep schedules as routine as possible, while including guests in family activities, such as walks, grocery shopping, sporting or school events, etc. • Attend the planned activities in the local community. • Take photographs to share with your guests and others at the closing ceremony.
    This is a required question

    Host Contact Information (Primary contact person)

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Host Family Member Information

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Doe anyone in your family speak Japanese?
    Has any one in your family done a home stay abroad?
    Has your family hosted a guest for a home stay before?
    Has any one in your family traveled to Japan?
    Does anyone in your family smoke indoors?
    Are you willing to host someone who smokes (indoors)?
    Are you willing to host someone who smokes (outdoors)?
    Do you have any indoor pets?
    Do you have any outdoor pets?
    Has anyone in your household ever been convicted of a felony? (If yes, you will be asked to complete a form explaining the conviction and consent to a criminal background check)
    Please enter one response per row
    This is a required question
    This is a required question

    Guest Accomodations

    This is a required question
    This is a required question
    This is a required question

    Legal

    2016 Japan-America Grassroots Summit Host Participation Agreement As used in this Agreement, the “Host” is the “Primary Contact” (as set forth in the Application) person submitting the Application to be a host for a Japanese guest, and the “Host Family” members are those household members (including the Host) over the age of 18 who sign the Application. As a Host Family for a Japanese guest or guests (the “Guests”) for the 2016 Japan-America Grassroots Summit (the “Summit”), each member of the Host Family agrees as follows: 1. The Activities. The “Activities” include all activities pertaining to the Summit, including, but not limited to, hosting of one or more Guests, engaging in “grass-roots” diplomatic activities, and providing lodging, food, and reasonable assistance to the Guests at the Host's household. 2. Agreement to Conduct Due Diligence with Allergies and Assist with Medical Care. While there is no obligation to incur expenses for providing medical care to a Guest during or after the Activities for causes arising without the fault of the Host, the Host agrees to provide reasonable assistance to any Guest in need of medical care and agrees to reasonably inquire as to any food allergies of any Guest and to inspect all food for ingredients related to any allergies identified by Guest. 3. Financial Responsibility. The Host understands that the Host is solely responsible for expenses the Host may incur in connection with and during the Summit (e.g., fees for meals or transportation for Guest that are not arranged for or provided by the Summit organizers). 4. Assumption of Risk; Release and Discharge. The Host, each member of the Host Family, and each of their respective personal representatives, heirs, and assigns (collectively, the “Host Parties”) understand the Activities, knowingly assumes all risks associated with, resulting from, or arising out the Host Parties' participation in the Activities, and fully releases and discharges the Japan-America Society of Georgia, the John Manjiro Whitfield Commemorative Center for International Exchange, and CIE-US and their respective officers, directors, agents, employees, and representatives (collectively, the “Released Parties”), from any and all liability incurred by any Host Party, or for any and all damages and injuries incurred by any Host Party. Each Host Party further waives any claims against and agrees not to sue any of the Released Parties for any and all damages of or injuries to one or more of the Host Parties, whether or not caused by negligence or carelessness of any of the Released Parties. 5. Interpretation and Authority. Georgia law shall govern this Agreement without regards to its conflict of laws principles. This Agreement shall be binding upon the respective heirs, successors, and assigns of each Host Party. The Host and each member of the Host Family have read and understands the statements made above, and voluntarily signs the Host Application. The Host and each member of the Host Family acknowledge that no representations, warranties, statements, or agreements, apart from this Host Application have been made to, or is being relied on by, the Host or any member of the Host Family. Signatures: Must be signed by all Host Family members over the age of 18. Please note that, by signing this Agreement and submitting this Application, you are committing to become a Host Family for this important event. Once selected to become a Host Family, it will be extremely difficult for the organizers to re-evaluate and select a new host family. As such, we ask all potential Host Families to carefully consider their ability to take on this task, and to commit fully to the end once the Application has been submitted.

    Signatures

    Must be signed by all household members over the age of 18.
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
Request edit access