PARENT AUTHORIZATION FORM for under 18
18歳以下認証委託

Name of child ____________________________________________Age ___________

Home Address _______________________________________Phone _______________

         We(I), the undersigned, hereby grant permission of our (my) child________________to
participate in the Aloha Homestaysﾕ study program.
         We(I) grant permission to Aloha homestay and/ or host family to arrange for
transportation of___________________by private vehicle,  commercial vehicle, bus, and/ or
other means of transportation as required, and hold harmless the  Aloha homestay and/ or
the host families from liability resulting from the use of operation, or maintenance of any of
the above mentioned modes of transportation.

Program Period: from _______________200___to __________200 ___
         In the case of illness or injury to ___________________I hereby consent to and authorize
such medical treatment as deemed necessary, and agree to pay for such medical and
Hospital costs if incurred.
My child has medical coverage ___Yes : Name of insurance:_____________________________

AUTHORIZATION:

 ________________________________  ____________________________  _________
      print or type Mother's/ Guardian's Name                                  Signature                            Date
 

 ________________________________  _____________________________  ________
      print or type Father's/ Guardian's Name                                   Signature                             Date

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Authorization for Over 18

         In applying to be participant in the Aloha Homestay program, I agree to have a valid passport,
visa and medical insurance.  I further agree that Aloha Homestay's staff and Host families are not
responsible for my health and safety and I will pay any expenses incurred by them in taking action
necessary in the interest of my health and safety.
I have read and agree to the rules for listed in the Aloha homestay hand book.

___________________________    _________________________________   _________
            Print or type your Name                                                        Signature                               Date

Please print out this form and send to the Aloha Homestay.
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