Kinmon Gakuen Summer Classes 2025 Application Form
Japanese Classes for Kids Ages 5 to High School
Application deadline: Monday, May 26.
Note: If the minimum number of students is not met, the class will be canceled, and a refund will be issued. Registration will close once capacity is reached.
Entering Japanese Language Classes for Age 5 to 18
*
Every Saturday May 31 to June 28 10AM - 12PM
Basic
Hiragana Class (Beginner Level)
($250)
Introductory Kanji Class
($250)
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 May 31st, 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
*
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.
Please tell us the medium that led you to apply
Please tell us the medium that led you to apply
Friends or Acquaintances
Family
Bulletin board at supermarket, etc.
Flyer
Social Media (SNS)
Website
Guidebook or newspaper ad
Vivid Navigation
Web Bulletin board
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.
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Kinmon Gakuen Summer Classes 2025
Japanese Classes for Kids
$
250.00
Credit Card
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