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:

Full Name
Your answer
Your answer
Date of birth
Age (this homestay is limited for people with age 18-55 years old)
Your answer
Phone Number
Your answer
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)
Terms and Conditions
1. I understand that participation fee is not refundable if I cancel the registration after 20th of September 2017.
2. I agree to pay the travel insurance as part of the participation fee.
3. I understand that the insurance included in the fee of this home-stay only covered the following benefits:
- 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.
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.
6. I understand that I have to bring my personal needs and personal medicine that necessary during the home-stay.
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.
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.
I have read and agree to the above terms and conditions.
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