2019 Host Family Application

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Host Family Application Form

July 26 - August 5, 2019 

Sister City Exchange Program with Ushiku, Japan 

 

 

Willing to host: 
 *
Willing to host:
What is your Family Name?
What is your address? Include Street, City and Postal Code. 
What is your email address?
What is your cell phone number?
Phone number in case of emergency: 
Please upload a picture of your family below (please label it with your name). 
What is the best way to communicate information to you : 
 *
What is the best way to communicate information to you :
As a part of the program all adults residing in your house are required to undergo a Criminal Records Check.  
Are you willing to obtain a Criminal Records Check?     
 *
As a part of the program all adults residing in your house are required to undergo a Criminal Records Check. Are you willing to obtain a Criminal Records Check?

As a part of the program the City allows for host family youth (between Ages 13 – 18 / Grades 8-12) to participate in the weekday activities during the week. * Please note additional forms will be required to be completed for your youth. 

Do you foresee your children participating in the weekday programming?  


 *
As a part of the program the City allows for host family youth (between Ages 13 – 18 / Grades 8-12) to participate in the weekday activities during the week. * Please note additional forms will be required to be completed for your youth. Do you foresee your children participating in the weekday programming?

If yes, indicate below the child(ren)’s name, age and days they will be participating.  

Family Information

*Only information /details regarding those who will be in your household during the participant's visit is required. 

FATHER OR OTHER 

Please specify Name 

Please specify Relationship
What is their occupation?
What is their email address?

MOTHER OR OTHER 

Please specify Name 

Please specify Relationship
What is their occupation?
What is their email address?
CHILD(REN)
Name Age Gender
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6

OTHER(S) including Pets/Animals 

Please provide details 

Interests and Hobbies

This information will be used when matching our Japanese students and chaperones with Yukon Families.  Please provide us with as much information about your family’s interests, activities and hobbies.

Have you participated in the Ushiku Sister City exchange? 

 *
This information will be used when matching our Japanese students and chaperones with Yukon Families. Please provide us with as much information about your family’s interests, activities and hobbies. Have you participated in the Ushiku Sister City exchange?

Have you participated in other exchanges? 

 *
Have you participated in other exchanges?

Are you looking to send your youth on the 2020 exchange to Japan? 

 *
Are you looking to send your youth on the 2020 exchange to Japan?
Which of the following best describes your family?
 *
Which of the following best describes your family?
How does your family spend their free time? Please list the specific sports, musical instruments /activities, clubs, hobbies and leisure activities in which your family actively participates during the year.

Please write a short bio about your family that will be shared with your Japanese student and or chaperone and their families. 

Host Family Responsibilities

  • Host families are expected to meet their Ushiku student(s) or chaperone at the airport when they arrive, and to provide transportation to the airport when they leave.
  • During the weekdays, the City provides a full day itinerary of activities and excursions for the Ushiku students, from 8:30am to 4:30pm approximately (some times may change according to the itinerary i.e overnight camping trips). Host family youth are also included in these activities at no cost.
  • Host families are expected to provide transportation to the start location for each day’s activities and to provide transportation back to the family home at the end of each day (the start/finish point is usually a City facility such as City Hall, Sport Yukon Building or the Canada Games Centre).
  • During the evenings and weekends, the Ushiku students are hosted by their Whitehorse families, who take care of meals, accommodation and any other outings or excursions that they would like to involve their student in. * The City does not cover these costs on evenings/weekends, with the exception of the overnight camping trip and the final banquet which is usually held on the Sunday before departure. 

*Please note, that if a family intends to take their student to Skagway or Haines Alaska, the necessary paperwork must be provided at the border crossing. Your student / chaperone should be informed as they are required in Ushiku to complete forms and purchase out of Canada travel documents.

I/we realize that this is a limited program and that this application does not guarantee acceptance into the program. Furthermore, I/we understand that there are costs associated with the program that are the responsibility of the parent/child. I/we agree that all information provided will be shared with the students and their families. 
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