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(Application Form for Host Family)
【Basic Information】Please write your email address first here. メールアドレス=email address
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Email
*
Your email
登録にあたり希望者との契約書をお読みになりましたか。Have you read the contract?
*
はい / Yes
Required
Full Name
Your answer
Home Address (zip code including)
Your answer
Phone Number (Home)
Your answer
Phone Number (Mobile)
Your answer
E-mail Address
Your answer
Referred by (if anyone)
Your answer
Have you hosted students before?
Yes
No
Occasionally
Clear selection
Name of other Homestay agency you are currently registered with:
Your answer
Payment Recipient’s Name (payable to):
Your answer
GET NUMBER (if you already have one)
Your answer
【People Living in the house】
family information at home
Name #1: (First Name & Last Name)
Your answer
Gender
Male
Female
Other
Clear selection
Date of Birth / Current Age (ex. 01/31/1981 , 38)
Your answer
Occupation
Your answer
Name #2: (First Name & Last Name)
Your answer
Gender
Male
Female
Other
Clear selection
Date of Birth / Current Age (ex. 01/31/1981 , 38)
Your answer
Relationship
Spouse
Child
Other Family
Clear selection
Occupation
Your answer
Name #3:(First Name & Last Name)
Your answer
Gender
Male
Female
Other
Clear selection
Date of Birth / Current Age (ex. 01/31/1981 , 38)
Your answer
Relationship
Spouse
Child
Other Family
Clear selection
Occupation
Your answer
Name #4:(First Name & Last Name)
Your answer
Gender
Male
Female
Other
Clear selection
Date of Birth / Current Age (ex. 01/31/1981 , 38)
Your answer
Relationship
Spouse
Child
Other Family
Clear selection
Occupation
Your answer
Name #5:(First Name & Last Name)
Your answer
Gender
Male
Female
Other
Clear selection
Date of Birth / Current Age (ex. 01/31/1981 , 38)
Your answer
Relationship
Spouse
Child
Other Family
Clear selection
Occupation
Your answer
【Information About Your House】
Property
Own
Rent
Other
Clear selection
House Type
1 Single Family Home
2 Multi Family Home
3 Condominium / Appartment
4 Other
Clear selection
Number of rooms for hosting
1
2
3
4
5
rooms
Clear selection
Minutes to the closest bus stop by walk (...min)
Your answer
Any Pet
Yes
No
Clear selection
If Yes, Whats kind?
Your answer
Any smokers?
Yes
No
Clear selection
Speak Language
English
Japanese
Other
Clear selection
Interest & Hobbies
Your answer
【Food & Amenities】
Typical Breakfast
Your answer
Typical Lunch
Your answer
Typical Dinner
Your answer
Wi-fi
Yes
No
Clear selection
What is the good point around your property? (ex.:Safe and very quiet nice neigborhood...)
Your answer
【Preferences】
Meal Plan
Yes
No
Both are ok
Clear selection
Gender
Male only
Female only
Both are ok
Clear selection
Length
Short term
Lont term
Both are ok
Clear selection
Smoking
Yes
No
Both are ok
Clear selection
Submit
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