Winter Chinese Programme 2019

Child’s SURNAME/FAMILY Name (in English Alphabet)

Child’s GIVEN Name (in English Alphabet)

Child’s DOB(day/month/year)

GenderBoyGirl

Nationality

RESIDENTIAL Address (in English) to send an invoice to (NOT Email address)

Parent’s SURNAME/FAMILY name (in English Alphabet)

Parent’s GIVEN name (in English Alphabet)

ParentMr.Mrs./Ms.

Parent’s Mobile number(000-0000-0000)
Please include a Country code if you reside outside of Japan

Parent’s Email Address

Food Allergies
(If it’s eggs & dairy, please tell us if your child can consume baked goods using eggs & dairy such as bread)

Joining
Dec 16Dec 17Dec 18Dec 19Dec 20

Please read below and check the consent button:

Agreed to the following (A) (B) & (C)

(A) I am responsible for the school fees and understand that the school does not provide any makeup classes or refund for any reasons.

(B) I understand and agree that any changes including dates, etc cannot be made to the signup requests once the submit button of this page is clicked.

(C) I understand that by clicking the submit button, my child is officially being signed up and an invoice will follow.

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