Kinmon Gakuen Summer Classes Application Form
Japanese Classes for Kids Ages 5 to High School
In-Person Summer School Programs
Application deadline: Monday, May 27th. Note: Registration will close once capacity is reached.
Entering Japanese Language Classes for Age 5 to 18
*
Every Saturday June 1st to 29th 10AM - 12PM
Hiragana -Beginner ($220)
Kanji I -Intermediate ($220)
Kanji II -Advanced ($220)
Student Information
We kindly ask that siblings also fill out separate registration forms.
Name
*
First Name
Last Name
Grade
Japanese Language School Last Attended
Gender
Please Select
Male
Female
N/A
Date of Birth
-
Month
-
Day
Year
Date
Age as of June 1st, 2024
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Alternate Contact Email 2, if needed
example@example.com
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first
*
Emergency Information
Name
First Name
Last Name
Relationship
Phone Number
Health Information
Family Doctor
First Name
Last Name
Clinic
Phone Number
Please let us know if this child have any allergies
List medications if this child is currently taking
Have this child had any serious illnesses or operations?
Yes
No
If yes, please describe
Do you want to share any more related information?
Waiver and Release of Liability
Photo Release Permission
As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken during the course of the school year for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet, SNS or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
*
Yes, I give consent for Golden Gate Institute, Kinmon Gakuento photograph my child for school purposes and/or at school events.
No, I do not authorize Golden Gate Institute, Kinmon Gakuento photograph for my child for any event.
Signature
Date of Registration
*
-
Month
-
Day
Year
Date
Signature
*
Payment
Please make payments separately for each student. We kindly ask that siblings also fill out separate registration forms.
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Kinmon Gakuen Summer Classes 2024
Japanese Classes for Kids
$
220.00
Credit Card
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