VS Oceania - Travel Arrangements

Student's First Name *

Student's Last Name *

Student's Address *

Student's Phone Number *

Student's Email *

Student's Date of Birth *

Student's Age *

Student's Gender *

Female

Male

Non-binary

Other

School Name *

Year *

Please indicate how many OTHER people live in your household (NOT including the student filling in this form) *

PLEASE LIST OTHER HOUSEHOLD MEMBERS BELOW:

OTHER HOUSEHOLD MEMBER #1

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #2

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #3

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #4

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #5

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #6

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #7

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #8

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #9

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #10

Name *

Age *

Relationship to Student *

School or Occupation *

OTHER HOUSEHOLD MEMBER #11

Name *

Age *

Relationship to Student *

School or Occupation *

My spoken Japanese level is: *

Poor

Basic

Good

Very Good

My written Japanese level is: *

Poor

Basic

Good

Very Good

Please write a brief comment about why you are doing a Japanese Homestay (including what you would like to do when you graduate school) *

I like to eat: *

I don't like to eat: *

I like animals: *

Yes

No

You indicated you DO like animals - please list the animals you especially LIKE: *

You indicated you DON'T like animals - please list the animals you especially DISLIKE (include any you are allergic to): *

Please list your favourite hobbies, sports and other interests *

Please list the types of activities you enjoy: *

When I am in Japan, I would like to: *

I am taking medication *

Yes

No

Please list any medication you are taking, including dosage and frequency *

I have an allergy/allergies *

Yes

No

Please list any allergies, including severity (mild, moderate, extreme). If you have an allergy that requires treatment/medication to be administered, please include detailed information: *

Attach a photo of yourself with your family or friends (you can upload up to 3 photos - max. file size 5MB)

TIP: In your introduction letter (below), let your family know which person is you in the photo

Drag and drop files here or Browse

Please write a brief introduction letter to your host family: *

TIP: Also bring photos of your family, friends and home to share with your host family

I give my consent for my son/daughter to participate in all school and homestay activities (both in and out of the school and homestay premises) including all excursions arranged by the school and homestay provided during the program. *

Yes

No

I agree that any homestay organization or its agent can take any action whatsoever in regard to my son’s/daughter’s health and safety without incurring any liability or expense. This may include, but not be limited to, hospitalization, use of medical services and where required transport back to home country at my expense. *

Yes

No

I agree that no homestay provider will be held liable for any accident or injury, loss of possessions or personal items due to negligent behavior on part of my son/daughter. *

Yes

No

I agree that my son/daughter will abide by the rules and regulations regarding the homestay program. *

Yes

No

I agree to reimburse the host family, the local school or the homestay organization for any undue damages caused by my son/daughter. *

Yes

No

Student's Signature *

Date *

Parent/Guardian Name *

Parent/Guardian Signature *

Date *

reCAPTCHA Checkbox *

Who We Are

Homestay

Value Learning

Study Tours to Australia

Community Involvement

Homestay Placement

School Tours to Japan

Individual School Experience to Japan

Travel Preparations

Travel Arrangements

Homestay Questionnaire

Suite 23/33 Waterloo Road,
North Ryde NSW 2113

Phone: +(612) 9889 4366

Fax: +(612) 9887 3254

Email: admin@vsoceania.com

Who We Are

Homestay

Value Learning

Suite 23/33 Waterloo Road, North Ryde NSW 2113

Phone: +(612) 9889 4366

Fax: +(612) 9887 3254

Email: admin@vsoceania.com

Suite 23/33 Waterloo Road,
North Ryde NSW 2113