APPLICATION FORM

We will send the result of your request to your E-MAIL address, so please confirmto fill your E-MAIL.
If you do not like filling these information but have any question, please fill only E-mail, name, and question. We will send back to you.
NAME：
COUNTRY：
ADDRESS:
ZIP CODE:
TELEPHONE NUMBER:
COUNTRY CODE:
E-MAIL ADDRESS:

GENDER：
MALE
FEMALE

YOUR EXPECTED FIRST DAY TO STAY:
YOUR EXPECTED LENGTH TO STAY:
PERSON'S NAME FOR EMERGENCY:
TELEPHONE:
ADDRESS:

DO YOU MIND IF THE HOST FAMILY HAS A PET IN THEIR HOUSE?：
DO NOT CARE
YES

DO YOU SMOKE IN THE HOUSE?：
YES
NO

DO YOU DRINK ALCOHOL IN THE HOUSE?：
YES
NO

ARE YOU ABLE TO SPEAK JAPANESE FOR GENERAL COMMUNICATION?：
YES
NO

HOW OFTEN DO YOU WANT TO SPEND TIME WITH HOSTFAMILY IN A DAY?：
AS MUCH AS POSSIBLE
OFTEN
LEAST
NO IDEA
NOTE：

　SEND THIS APPLICATION WITHOUT CONFIRM