Kakegawa 2023 Application
All Information is stored on our secure site and is deleted after the trip is complete. Application Due March 26, 2023.
This may take about 45 minutes. Please make sure you have a steady internet connection. Progress may be lost if you lose connection. Please have a photo of your passport ready to upload. If you are writing a financial assistance essay, please prepare it in advance and paste in the designated field (bottom of page). If you have travel insurance, you can also submit photos (not required until May). If you are under 21, please have a parent ready to review and digitally sign documents.
We will review these documents with you at our first meeting after travelers are approved.
Need Help? E-mail Corning.Kakegawa.SC@gmail.com
Traveler Bio
We will use this information to contact you, parents, and prepare documents for our Japanese Organizers.
Tell us about what activities you like. What sports, instruments, hobbies, or creative things you like to do.
Tell us if there is anything specific you would like to do with your host family.
Tell us about your family. This will the Japanese Organizers place you with a matching host family.
Example: Jane Doe
Mother
Office Worker
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Reading, Jogging, Scrapbooking
Parent, Guardian, or Responsible Adult Information
We will use this information to contact a parent, spouse, or another adult in case of emergency.
Behavioral Contract (under 21)
The Traveler shall in all respects act in accordance to the laws, rules, and regulations of Kakegawa, Japan and their local school/college’s handbook. Students are subject to the provisions and penalties contained therein, in addition to the rules listed below by Sister Cities Association of Corning, New York.
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No alcohol use if you are under 21.
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No illegal drug use.
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No dating during the trip.
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Adhere to the rules of the household where you are staying.
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You must be covered by medical insurance.
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Bring your own medications and report any medical problems or special dietary requirements.
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Breaking any of these rules will result in early dismissal from the trip at parent/guardian/personal expense.
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The Undersigned agree that their digitally written name represents a signature of agreement and understanding.
Travel Permission (under 21)
I give permission for my undersigned child to attend the July 2023 trip to Kakegawa, Japan with the Kakegawa group of Sister Cities Corning.
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The Undersigned agree that their digitally written name represents a signature of agreement and understanding.
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Authorization for Medical Treatment of Minors
In the case of an unexpected medical emergency, this information will be provided to the appropriate healthcare professional, physician, dentist, or hospital representative. This form will be provided to your chaperones and should be carried at all times while on the trip. We will provide copies for you to review before we go to Japan.
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I,/ We, being the parent (s) or legal guardian(s) of the above named minor do here by appoint:
Shari Holland (trip chaperone)
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To act in my/ our behalf in authorizing unexpected medical, dental, surgical care and hospitalization for the above named minor during the period of my /our absence while in Japan, during July, 2023.This document may be presented to a physician, dentist or appropriate hospital representative at such time as unexpected medical, dental, surgical care, or hospitalization may be required.
*All travelers are required to provide proof of travel insurance. Sometimes this is already provided in your coverage plan. Check with your company to see if you or your child are already qualified.
If you do not have medical travel insurance yet, you may wait until May 1, 2023 to provide a photo of your card.
Release of Liability
READ CAREFULLY – THESE ARE YOUR LEGAL RIGHTS
In exchange for participation in the Sister Cities Association of Corning, NY, Kakegawa Committee sponsored trip to Kakegawa, Japan, July, 2023 I agree for myself and for the member of my family, to the following:
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I agree to observe and obey all rules and warnings and further agree to follow any oral instructions or directions given by the chaperone.
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I recognize that there are certain inherent risks associated with the international travel connected with the above trip. I assume full responsibility for personal injury to myself and family members, and release and discharge Sister Cities Association of Corning, NY; members of the Kakegawa committee, and trip chaperone(s), for injury, loss or damage arising out of my participation in this trip, whether caused by the fault of myself, my family, the chaperone, Sister Cities Association of Corning, or Sister Cities Association of Corning-Kakegawa Committee.
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I agree to indemnify and defend Sister Cities Association of Corning, Sister Cities Association of Corning-Kakegawa committee, and trip chaperone(s) against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or family’s participation in the July, 2023 Sister Cities-sponsored trip to Kakegawa.
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I UNDERSTAND THAT COMMITTEE MEMBERS HAVE ADVISED TO CONTACT PROFESSIONALS IF I HAVE ANY SAFETY CONCERNS. I FURTHER CERTIFY THAT I UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
Financial Assistance Essay
Pending available funds, Corning - Kakegawa Sister Cities Committee offers some financial assistance to students who have the desire to travel, learn about a new culture, continue the Sister Cities International mission. In order to be awarded financial assistance, students are required to write an essay explaining why they need assistance to make this trip possible.
Please be as thorough as possible. Although we do not require a minimum word count, students should complete a detailed and thoughtful response to the prompt in order to be considered for an award. Essays will be reviewed by the committee and help us decide who deserves this award the most. The committee will award 1 to 2 travel scholarships after reviewing all complete applications.
The Corning-Kakegawa Committee understands that the essay may contain sensitive or personal information. We will not share applicants’ identity or information without the applicant’s prior knowledge or consent.
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Essay Prompt:
Explain why you think you deserve or need financial assistance for the trip. How do you feel visiting Japan may affect your outlook personally, or on the world? Include special circumstance(s) that might affect your ability to pay the full cost of the trip.
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