Name *
Please use capital letters with your family name. For example: Taro TANAKA or TANAKA, Taro
Gender *
\nFemale
Male
Please select Female or Male.
Nationality *
If you are Japanese, please enter Japanese in this field.
Passport Number *
Please enter your number as it appears on your psssport.
E-mail *
Type your email address. For example: you@email.com
Date of Birth *
When were you born? Please enter your date of birth of birth as: Month/Day/Year. For example: December 12, 1966.
Telephone Number *
Enter your telephone number in this format: Country-Area-Number
Permanent Address *
Use western style when writing your address. The format should be Your Name,Street, City, State, Zip Code, and Country.
Facsimile
Enter your facsimile number in this format: Country-Area-Number
English Level
L owM ediumH igh
Enter your English level. Medium is pre-selected as your English level. If your level is higher or lower than this, then make the adjustment yourself. Please note that most schools will give you a pre-test to determine your level.
Check-In Date
**IMPORTANT:** We would like you to check in and check out on a Saturday or Sunday. Arrivals on weekdays will be charged an additional of one hundred dollars.
Check-out Date
Check out must be at least 1 week after your Check-in date.
Arrival Date
Enter your arrival date.
Arrival Time
Use the 24-hour clock for your arrival time. If you are going to arrive at 5:00 in the afternoon, please enter 17:00.
Airport
Airline and Number
What is your flight number?
Purpose of Visit
E ducationalV acatioinO ther
What is the purpose of your visit?
Smoke? *
\nYes
No
Do you smoke?
Pets? *
\nYes
No
Do you like pets?
Children Ok?
\nYes
No
Are children ok in the home?
Allergies?
\nYes
No
Do you have any allergies or medical conditions?:
Explain Allergies
If yes, please provide details of your allergies or medical conditions.
Hobbies?
What are your hobbies or interests:
Car? *
\nYes
No
Will you have a car?
International Drivers License? *
\nYes
No
Do you have an international drivers license?:
Anything else?
Is there anything else you would like us to know?
Services
F ull YearS hort TermH omestay OnlyS ettlement
If you have selected SHORT TERM Guardianship, please select the number of weeks you require our service below. Please send us an email at info@ohanaryugaku.com for details of our rates.
Number of weeks?:
\n1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Please select the number of weeks you require our service below for Short Term Guardianship.
