Eco-Cultural Homestay registration
Event Schedule: Oct 06-08, 2017
Event Address: Kitahiroshima Cho, Hiroshima Prefecture
All the information you provide here are confidential and only for this event registration.
We will send you confirmation email and payment method after the registration is done.

Contact: e-mail: subaragoi@hiroshima-u.ac.jp

Full Name
Your answer
Nickname
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
Age (this homestay is limited for people with age 18-55 years old)
Email
Your answer
Phone Number
Your answer
Nationality
Your answer
Status (Please fill in also the company name or university name or any other affiliation where you belongs).
Company name/Business field/School/University/Affiliation
Your answer
Your Japanese language skill
Your English language skill
Other language that you master (including native language)
Your answer
Address (place to pick you up)
Do you need special assistance (example: wheelchair)
If yes, what kind of assistance do you need ?
Your answer
Religion (free answer)
Your answer
Dietary restrictions ( for allergy or any other restriction please write down on others)
Allergies (weather, food, specific items, etc)
Motion sickness tendency
If the host family have pets at their house
Any health issue that we have to be concern
Can you ride bicycle ?
Hobby (more than one answer is OK)
Your answer
Any activity you wish to do during homestay (cooking Japanese food, making Japanese handicraft, etc)
Your answer
Name of family member or contact person (in Japan or in your country, 1-2 persons)
Your answer
Relationship with the family member or the contact person you provided above
Your answer
I understand that I will have to pay 25,000 Yen in advance (within 5 days after the you receive confirmation email)
Required
Terms and Conditions
1. I understand that participation fee is not refundable if I cancel the registration after 20th of September 2017.
2017年9月20日以降にキャンセルした場合、参加費用の払い戻しはありません。
2. I agree to pay the travel insurance as part of the participation fee.
参加費には旅行保険代も含みます。
3. I understand that the insurance included in the fee of this home-stay only covered the following benefits:
参加費に含まれる旅行保険が適用できるのは以下の項目についてです。
- Death, Accident: 10 million yen
死亡・傷害 1000万円
- Hospitalization: 4,000 yen per day
入院日額 4,000円
- Surgery: 20-40 thousands yen
手術 2~4万円
- Hospital visit: 2,500 yen per day
通院日額 2,500円
4. I understand that I have to hold responsibility for my belongings and my own safety during the home-stay.
ホームステイ期間中の所持品や自身の安全は自己管理でお願いします。
5. I understand that the home-stay contains light physical activities that require average strength including hiking, fishing, farming, and riding bicycles (when necessary). Participants should bring proper clothing and be prepared for such physical activities.
このホームステイはハイキング、魚釣り、農作業、自転車による移動(必要に応じて)などの平均的な体力を必要とする軽い身体運動を含みます。動きやすい適切な服装で参加してください。
6. I understand that I have to bring my personal needs and personal medicine that necessary during the home-stay.
ホームステイ期間中に個人的に必要な医薬品やその他個人で必要なものは、各自で持参してください。
7. I understand that my food preference provided in the registration form reflects meals choices that will be offered by organizers based on their capacity.
参加申込書で記入いただいた食物の嗜好につきましては、主催者が提供できる範囲に基づき食事の選択肢に反映され提供致します。
8. I understand that the home-stay organizer hold responsibility to facilitate participants stay and being responsible for troubles and issues only during the home-stay days according to their capacity. In case of inconvenience, I will inform the home-stay organizer about the issues during the home-stay days. Organizers are not responsible for the troubles and issues after the home-stay finished.
主催者はホームステイ期間中にのみ参加者を支援し、同期間中に発生した問題に関してのみ対処する責任を負います。ホームステイ期間中に不具合が生じた場合は主催者にお知らせください。ホームステイ終了後に生じた問題に関しては主催者は責任を負いません。
I have read and agree to the above terms and conditions.
Required
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