Kinmon Gakuen Fall 2024 - Spring 2025 Application Form
Japanese Classes for Kids Ages 5 to High School
In-Person Saturday Programs Spring Semester
Application deadline January 4. Note: Registration will close once capacity is reached.
Entering Japanese Language Classes for Age 5 to 18
*
Every Saturday 9AM - 12PM
Beginning I
Beginning II
Intermediate
Pre-Advanced
Advanced
Still undecided; to be determined later
Student Information
We kindly ask that siblings also fill out separate registration forms.
Name
*
First Name
Last Name
Japanese Name (If applicable)
First Name
Last Name
Grade
Japanese Language School Last Attended
Gender
Male
Female
N/A
Date of Birth
-
Month
-
Day
Year
Date
Age as of January 11, 2025
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
*
Student's Background
What is the primary language at home?
English
Japanese
Chinese
French
Spanish
Other
Other
Whose idea is it to attend a Japanese Language school?
Parents
Student's
Other
Other
Is this his/her first time attending a Japanese language school?
Yes
No
If No, where has he/she attended before?
Comments and Expectation from guardians.
Emergency Information
Please list in order of whom to contact first
Name
First Name
Last Name
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
Please fill out and submit the Waiver and Release of Liability form separately.
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.
Please tell us the medium that led you to apply
Please tell us the medium that led you to apply
Friends or acquaintances
Family
Kinmon Gakuen Website
Social media (SNS)
Flyer or Pamphlet
Bulletin board at supermarket, etc.
Web Bulletin board
Guidebook or newspaper advertisement
Vivid Navigation
Other
If "Other", please specify where
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. If the applicant is siblings, please select the Sibling Discount for payment.
prev
next
( X )
Registration Fee
The registration fee is a one-time payment per academic year. Those who have already paid for the fall semester do not need to make a payment for the spring semester
$
50.00
Spring Semester
January 11 2025 to May 17 2025
$
450.00
Sibling: Spring 2025
Sibling discount: Please fill out separate application forms for each sibling and make payments at the time of each application. We apologize for the inconvenience and appreciate your cooperation.
$
430.00
Credit Card
Submit
Submit
Should be Empty: