Japanese Language Immersion Programs Host Family Questionnaire

 

Staying with a Host Family is the ideal way to learn more about the Japanese way of life and to practice your conversation skills. All our host families are carefully interviewed by our Home stay Coordinator, and they are regularly visited to ensure high standards are maintained. Families have been selected on the basis of them having expressed an interest in sharing their culture with international students.

 

To help us match you with the most suitable Host Family (depending on availability) please complete following information by hand (in Japanese where possible).

 

Name: _______________________________________

 

1. Do you have any allergies?     □ Yes     □ No    If yes, please give details: ____________________________________

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2. What are your favorite foods?

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3. Are there any foods you can’t eat?   If yes, what are they?

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4. State of Health

                        □ Very Good    □ Good         □ Not Very Good

                        □ Medical Requirements       □ Dietary Restrictions

5. Are dogs or cats OK?         □ Yes             □ No

6. Do you smoke?                   □ Yes             □ No

7. Do you drink?                      □ Yes             □ No

8. What type of music do you enjoy?

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9. What type of TV program do you enjoy watching?

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10. What kind of books or magazines do you like reading?

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11. What are your hobbies?

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12. What is your favorite sport?

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13. Character

            □ Sociable    □ Cooperative      □ Positive                □ High Achiever

            □ Shy             □ Humorous        □ Like Children       □ Like Pets

14. Arrival Details

Arrival Date:              Arrival Time:              Flight No:                     Departure Airport:                                                     

15. Have you ever been to Japan before?

□ Yes (Purpose:                                                    )              □ No

16. Please give a short introduction of yourself:

 

I hereby accept that the Academy of Japanese Language and Culture and its staff, or host family may act as responsible guardians for myself, (my son/daughter) and may decide on emergency medical treatment including surgery, without personal liability.

 

I agree to reimburse the Host Family or the Academy of Japanese Language and Culture for any damage I (my son/daughter) cause.  

 

I hereby remise, by releasing the Academy of Japanese Language and Culture and any of their staff, and any of the host family members, of all manner of actions, and financial or other responsibilities, and of claims and demands which may arise out of participation in your courses.  I agree that I (my son/daughter) must comply with all of the rules and regulations of your courses, or I (he/she) will be returned home immediately under my financial responsibility.

 

 

                                                                                                                                                                                            

Signature of Student      /　Signature of Parent (if student is under 20)              　　　     　　Date