ハワイ島コナのホームステイ・バケーション・スタディー・プログラム&語学学校

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ハワイ島の語学学校・ホームステイ & バケーション・スタディー・プログラム

Name:
Age & Birthday:
Address:
Telephone Number:
Emergency Contact (Name):
Emergency Contact Telephone Number:
Email Address:
Occupation:
Please list some hobbies & Interests:
Do you have allergies?
Do you have any medical condition that requires special care?
Do you smoke?	Yes No
Do you like Children?	Yes, I Do. No, I don't.
Do you like pets?	No I don't Yes, All OK Dogs Only OK Cats Only OK
Can You swim?	No, Not at All. Yes. No Problem. A little (at least 10 meters)
What are some of your favorite foods?
What are some foods you can't eat?
What other countries have you travelled to?
How many times have you been to Hawaii?
How is your English?	Worried Maybe Ok Pretty Good Confident
Comments: