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2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Primary Phone Number*
12. Mobile Number*
14. Email Address*
16. Hosting Preference *
    -- Select One --FemaleMale
17. Number of Person(s) you can host*
    -- Select One --1234
19. Please list family members living at home, including you:*

    Include names, age and employment/other

21. Upload a family photo/s*
23. Hobbies/Interests*
25. Message to Delegate
27. Have you hosted a homestay before? If so, when?*
28. Do you have pet(s)? If so, what kind of pet(s)?*
30. Please list two references:

    Include full name, phone number and email.

32. Photo release

    The activities that take place during the delegation visit will be photographed by the City of Forest Grove and/or parties designated by the City of Forest Grove. Photographs will be publicized. 

    Do you authorize the City of Forest Grove and/or parties designated by the City of Forest Grove to copy, reproduce, and/or publish your photograph and/or recorded audio or video for the purpose of advertising, display, audio/visual and public relations of the the Nyuzen Delegation Visits on social media and/or on the City of Forest Grove website?

33. Photo Release Agreement*
    -- Select One --YesNo
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field