-MUST be same as your passport-
RequiredSur Name
RequiredFirst Name
Middle Name
RequiredDate of Birth(Y/M/D)
*Japanese bedding may not be capable if your height is over 190cm or your weight is over 100kg. Please fill them out for providing appropriate bedding.
*Japanese bedding may not be capable if your height is over 190cm or your weight is over 100kg. Please fill them out for providing appropriate bedding.
RequiredNumber of ParticipantsExcluding the applicant
*We will mail you with details on other applicants at a later date.
RequiredNumber & street name
RequiredPostal Code
RequiredPhone number
RequiredMobile number
RequiredE-mail address
RequiredE-mail address (TYPE AGAIN)
RequiredSur Name
RequiredFirst Name
Middle Name
RequiredPhone number
RequiredE-mail address
RequiredPassport Country of Issuance
RequiredPassport number
RequiredPassport Date of Expiry (Y/M/D)
Arrival Date (Y/M/D)
Arrival Time
Flight Number
Arrival Airport
RequiredHomestay Start Date
RequiredWhat language(s) do you speak?
RequiredMy spoken English Level
RequiredMy spoken Japanese Level
RequiredDo you plan to smoke in Japan?
*Please keep in mind, Japanese law prohibits smoking for minors under 20years old.

Any pets you don’t like?
What foods do you rather not eat?
RequiredDo you have any food restrictions?

If yes,Please describe.
RequiredIs there any other important information for your host family to know
(religion, personal habits, etc.) ?
If yes,Please describe.
Do you have any special medical conditions, allergies, or physical disabilities ?
(E.g.Medical conditions,Physical disabilities,Mental illnesses /ADHD, depression, autism, or other intellectual disabilities/ Allergies / pets, medication, stinging insects, house dust/etc.)
If yes,Please describe any conditions you may have as it is very important information to your host family in order to prepare welcoming you to their home.
If you have any special requests for your host family, please list them here. We’ll try our best to accommodate your request, but we can’t guarantee it.
RequiredI declare that above information to be true and accurate to my best belief. I have read and understand the following homestay agreement of Nextage Co., Ltd. I understand/agree to all of the rules and regulations and apply for this program by selecting below.
-Homestay Agreement Form-
The visitor from overseas, shall be referred to as the “Guest”, “you” or “your”. The host family shall be referred to hereafter as the “Host”, and Nextage Co., Ltd Homestay in Japan shall be referred to hereafter as “Homestay in Japan”. The Guest will agree to abide by the terms and responsibilities set forth below for the duration of the homestay arranged by Homestay in Japan. Homestay in Japan will act as an agent between the Host and the Guest, but will not act on behalf or in the place or as a legal representative of either party. Homestay in Japan also does not offer, expressly or implied, any kind of financial guarantee or any other guarantee other than those expressly set forth herein, ordoes not take on any financial or other responsibility other than those expressly set forth herein. 

➢ About Homestay program

1. Terms and conditions

(1) Bed or futon will be provided for the Guest. Ordinary beddings in Japan are designed for a person of up to 190 cm (6.3 feet) height and up to 100 kg (220 lb) weight. Please fill in your height and weight in an application form in order for the Host to prepare suitable beddings. 

(2) Meals will be provided in accordance with your plan. 

(3) Guest will be responsible for paying any of their personal phone charges, cleaning bills, purchases of everyday items and goods, or any expenses other than those expressly set forth herein. 

(4) The Host will be responsible for preparing meals and paying electricity and water charges. Costs and expenses for such meals, electricity and water charges are included in the below Homestay fees. 

(5) The Guest shall respect and comply with the rules of the Host’s home.. 


➢ Responsibilities of the Guest 

1-1 In the event of staying overnight elsewhere or when dinner or breakfast is not required, the Guest shall contact the Host by the time agreed to beforehand. 

1-2 The Guest shall at all times inform the Host of the Guest’s contact information. In the event of staying overnight elsewhere, the Guest shall inform the Host of their contact information to be used in the event of an emergency. 

1-3 The Guest shall take full responsibility for all personal valuables and belongings during the homestay. Homestay in Japan takes no responsibility in the event of fire, natural disaster, robbery or other loss of said belongings. 

1-4 The Guest shall: (i) not let any other person stay overnight or live in the Guest’s room or any part of the Host’s residence; (ii) not bring any dangerous or extremely heavy objects in the Host’s residence or its premises; (iii) not make loud noise, emit unpleasant smell, make noise in the midnight or early morning, nor cause a nuisance to the Host or its neighbors; 

1-5 The Guest agrees that any liability or expense including, but not be limited to, hospitalization, use of doctors’ services and transportation is the Guest’s responsibility. 

1-6 The Host shall not be held liable for any accident, damage or injury, loss of possessions or personal items incurred by the Guest in connection with the homestay unless such accident is caused intentionally or by gross negligence of the Host. The Guest shall agree to reimburse the Host, local accepting organization or Homestay in Japan for any damages caused by the Guest or his/her friends or any visitors to the Guest's room. Homestay in Japan shall not be liable for any of the above accidents or damages on behalf of the Guest or for the Guest.     

➢ Responsibilities of the Host and Guest 

2-1 The Host shall not force the Guest to perform household chores or tasks, or to care for the Host’s children. The Guest will take responsibility to clean up the places after use (such as the Guest’s room, or the bathroom) and use them with care. 

2-2 The Host may, if deemed required or necessary by the Host, outline the house rules (such as meal times, curfews, telephone usage, bath/shower time limits, trash separation, use of the clothes washing machine) in written form and explain them clearly to the Guest. The Guest shall adhere to the house rules. The house rules must principally be of the same standard as the Host’s family, and any house rules that go against the terms of this Agreement will not be accepted. Any disagreements or problems with house rules that go against this agreement shall be resolved using this agreement as a guide. 

2-3 The Host shall not ask the Guest to pay for any living costs other than specifically set forth herein such as utilities costs. The Guest will endeavor to avoid using the telephone or bath/shower facilities for long periods of time. Permission must be acquired of the Host before any international or long distance phone calls, and any charges for such international or long distance phone calls by the Guest shall be paid in the manner agreed on by the Host and Guest; Homestay in Japan will take no responsibility in this matter. Furthermore, the Host shall not be required to pay for any miscellaneous costs outside of the ones required by this agreement (such as entertainment pursued by the Guest and/or recreation costs on holiday activities, etc.). The Host and the Guest shall mutually agree concerning payments for the Guest’s meals when said meals are eaten outside of the house. Any insurance taken out to guard against possible loss of property or damage that could be caused by the Guest is the responsibility of the Guest. 

2-4 The Host and Guest shall respect either party’s privacy. The Guest shall not enter the Host’s bedrooms, shower or bathrooms, or any other rooms that are prohibited from entering without permission. Furthermore, the Host shall not enter the Guest’s quarters without permission while the Guest is away, provided, however, that the Host may enter the Guest’s quarters for security or safety reasons in case of emergency such as a fire, earthquake, water leak, illegal intruders, or the like. 

2-5  The Host and Guest, respectively, shall contact Homestay in Japan, and not a third party, in the event of any trouble or circumstances that may arise between the Host and Guest that are not able to be solved amicably. Homestay in Japan will use its reasonable efforts to help the Host and Guest solve such trouble. 


➢ Responsibilities and Indemnification of Nextage Co., Ltd. 

3-1 Homestay in Japan makes the homestay arrangements for the purpose of helping the Guest find a suitable host family and homestay opportunity as much as possible. The homestay is an arrangement under mutual agreement between the Host and the Guest. Each of the Host and the Guest shall have rights to and responsibilities for the other party directly and shall settle any dissensions, troubles, or disputes with the other party. Homestay in Japan will not be responsible for any rights and responsibilities (including any delay or failure of the performance of obligations) between the Host and the Guest nor have any obligations of settling dissensions or disputes between them. 

3-2 Homestay in Japan shall not be held liable for any accident or injury, loss of possessions or personal items that may occur in connection with the Guest due to any cause or reason during the homestay period. The Guest shall agree to reimburse the Host or Homestay in Japan for any damages caused by the Guest or his/her friends or any visitors to the Guest’s room. Homestay in Japan shall not be liable for any of the above accidents or damages on behalf of the Guest or for the Guest. 

3-3 Homestay in Japan shall provide the Host and Guest with a phone number that is available for use in emergency situations. Homestay in Japan shall have the right to provide the Host with the homestay application filled in by the Guest. 

➢Termination, Force Majeure, and Confidentiality 

4-1 In any of the events below, Homestay in Japan shall have the right to terminate the homestay period by giving written notice to the Host. In the above case, the Guest shall remove his/her belongings and leave the residence of the Host immediately after such notice. 

(i) The Guest breaches the terms of this Agreement including any payment to Homestay in Japan or the house rules under section 2-4 hereof, and such breach is not remedied within one (1) week after notified of such breach by writing or email. 

(ii) The Guest states inaccurate or untruthful information on the homestay application form. 

(iii) The Guest creates a trouble or a problem that cannot be settled or resolved amicably with the Host. 

(iv) The Guest commits a crime or an act in violation of laws, regulations, or public order, morality or public health in Japan. 

4-2 In case the Guest leaves behind any of his/her belongings after the homestay period expires or terminates, the ownership in and the title to such belongings shall be deemed to be abandoned. The Host is entitled to dispose of the said belongings by means that the Host deems appropriate. 

4-3 The Guest acknowledges and understands that the Host or Homestay in Japan shall not be liable to the termination of the homestay due to any cause or causes beyond the reasonable control of the Host or Homestay in Japan affected, including, but not limited to, natural disaster; acts of government or governmental authorities, compliance with law, regulations or orders, fire, storm, flood, earthquake, or tsunami; war (declared or not), rebellion, revolution, riots, strike or lockouts, spread of an epidemic, power failure, an extreme shortage of energy or other resources. A sudden occurrence (or recurrence) of a serious disease or accident regarding the Host and inability to find othersuitable host family shall be deemed as a force majeure. 

4-4 The Guest agrees to hold in confidence any private or confidential information concerning the Host and all confidential information as regards Homestay in Japan (hereinafter collectively referred to as “Confidential Information”). The Guest further agrees not to make any disclosure of the Confidential Information to anyone. The obligation under this clause 4-4 shall continue after the expiry or termination of the homestay for any reason. 

➢ Miscellaneous 

5-1 Any communications between Homestay in Japan and the Guest shall be made in Japanese language or English language. In case the Guest contacts or communicates with Homestay in Japan in any other language, Homestay in Japan shall not be under obligation to respond or shall not be liable for any delay in response. 

5-2 This Agreement shall be governed, construed and interpreted in accordance with the laws of Japan. 

5-3 Any difference or dispute between Guest and Homestay in Japan concerning the interpretation or validity of this Agreement or any rights and liability between Guest and Homestay shall be submitted to Japan Commercial Arbitration Association in Tokyo, Japan and shall be settled by such arbitration in accordance with the Commercial Arbitration Rules of the Japan Commercial Arbitration Association. The number of arbitrator shall be one (1). The language for the arbitration shall be Japanese. The award thereof shall be final and binding upon the parties hereto. Judgment upon such award may be entered in any court having jurisdiction thereof. 

Personal Information Protection Policy 

Nextage Homestay in Japan collects and uses the personal information of our customers for specific purposes as set forth below, and unless otherwise set forth in the Act on the Protection of Personal Information does not collect or use the personal information for other purposes than the below purpose or is needed to achieve such purpose or is incidental thereto. 

How we use personal information Homestay arrangement and other related arrangements used for the program. 

I have read, fully understood, and agreed to the above provisions, rules and regulations and will abide by them. 

2018.010.15 revised
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