Full Name

In Kanji (If you have one)

Date of Birth

Gender *

Nationality *

Languages Spoken *

I am over 190cm / 6.3ft. *

I am over 100kg / 220lbs *

As Japanese beds are typically smaller compared to Western standards, we might have to make special arrangements for you.

Emergency Contact

What is your Engish Speaking Level *

Non Existent


What is your Japanese Speaking Level *

Non Existent


1 = Zero, 2 = Basic Knowledge, 3 = Intermediate, 4 = Advanced Stage, 5 = Close to Native Level

Have you ever done a homestay before? *

Do you have any special medical conditions? *

If yes, please state further information below. We will make sure that your host family can make special preparations to accommodate your needs.

Dietary Restrictions *

Allergies *

Do you have any other special requests or something that you would like to mention?

Please upload a photo of yourself, where your face is properly visible. Any casual photo is fine. *

Write a short letter to your host family or fellow housemates about yourself.