Kinmon Gakuen Fall 2025 - Spring 2026 Application Form

Kinmon Gakuen Fall 2025 - Spring 2026 Application Form

Japanese Classes for Kids Ages 5 to High School Aug 30 to May 16
Saturday Programs Fall Semester: Aug 30 - Dec 13

Application deadline August 26. Note: Registration will close once capacity is reached.
Saturday Programs Spring Semester: Jan 24 - May 16 2026

Application deadline January 17. 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 NameLast Name
Japanese Name (If applicable)

First NameLast Name
Japanese Name (if applicable): Last Name
Japanese Name (if applicable): First Name
Grade
Japanese Language School Last Attended
Gender

MaleFemaleN/A
Date of Birth

MonthDayYear
Date
Age as of August 30, 2025*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent(s)/Guardian(s) Information
Name: Parent(s)/Guardian(s)*

First NameLast Name
Relationship
Please enter your primary email address for school communication. We will send you an invitation to Google Classroom, so we recommend using a Gmail address. If you prefer to use a different email for communication, please write it in the next field.
Email*
example@example.com
Email 2, if needed
example@example.com
Phone Number*
Please enter a valid phone number.
Additional Parent/Guardian Name

First NameLast Name
Relationship
Additional Parent/Guardian Email (optional)
example@example.com
Additional Parent/Guardian Phone Number(optional)
Please enter a valid phone number.
Student's Background
What is the primary language at home?

EnglishJapaneseChineseFrenchSpanishOther
Other
Whose idea is it to attend a Japanese Language school?

ParentsStudent'sOther
Other
Is this his/her first time attending a Japanese language school?

YesNo
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 :Emergency Information

First NameLast Name
Relationship :Emergency Information
Phone Number :Emergency Information
Health Information
Family Doctor

First NameLast Name
Clinic
Phone Number :Family Doctor
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?

YesNo
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.
What led you to apply for this program?
Please tell us the medium that led you to apply

Friends or acquaintancesFamilyKinmon Gakuen WebsiteKinmon E-mailSocial media (SNS)Flyer or PamphletBulletin board at supermarket, etc.Web Bulletin boardGuidebook or newspaper advertisementVivid NavigationContinuing studentOther
If "Other", please specify where
Signature
Date of Registration*

MonthDayYear
Date
Signature*

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Payment
Please make payments separately for each student. We kindly ask that siblings also fill out separate registration forms.

For tuition, the first registered student is charged the regular rate of $500, and each additional sibling is charged the discounted rate of $480. The registration fee of $50 per student is charged only at the first registration of the school year. If it has already been paid for the Fall Semester, it does not need to be paid again for the Spring Semester.

When registering a sibling, please select the Sibling Discount option for payment.

Registration FeeThe 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

Fall SemesterAugust 30 2025 to December 13 2025

$500.00

Spring SemesterJanuary 24 2026 to May 16 2026

$500.00

Sibling: Fall 2025Sibling 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.

$480.00

Sibling: Spring 2026Sibling 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.

$480.00

Total

$0.00

Credit Card

Should be Empty:

Kinmon Gakuen Fall 2025 - Spring 2026 Application Form

Saturday Programs Fall Semester: Aug 30 - Dec 13

Saturday Programs Spring Semester: Jan 24 - May 16 2026

Student Information

Parent(s)/Guardian(s) Information

Student's Background

Emergency Information

Health Information

Waiver and Release of Liability

Photo Release Permission

What led you to apply for this program?

Signature

Payment

Credit Card