Course Registration Form (US)

Course Registration Form

Fill out the form carefully for registration
★This is the form for students who live in the U.S., Canada, Central America, and South America.
★If you live in Asia, please use the link below.

https://form.jotform.com/211278149907462
Please choose*

New StudentContinuing Student
Student Name*

First NameMiddle NameLast Name
Parent or Guardian Name (If a student is under 18)

First NameLast Name
Student's Date of Birth*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Alternative E-mail
Cell Phone Number*

Country CodeArea CodePhone Number
Phone Number

Country CodePhone Number
Alternative Phone Number

Country CodePhone Number
Alternative Phone Number

Country CodeArea CodePhone Number
Work Number

Country CodeArea CodePhone Number
Company or School name
Courses*

Basic 1 - Start on Wed. 1/15 (75 mins x 10 lessons)Conversation Class - Intermediate (60 mins)Easy Travel Japanese (25 mins x 5 lessons)Private Lesson for Kids (30 mins)Private Lesson (45 mins)Private Lesson (60 mins)Private Lesson (90 mins)Single Class (25 mins)Single Class (45 mins)Single Class (60 mins)
Schedule*

Saturday 2:30 - 3:45 pmOthers
Payment Method

Wise - *RecommendedPayPal
Lesson Package

One-time payment for Group LessonsMonthly10-Lesson Package (valid 14 weeks)20-Lesson Package (valid 28 weeks)
Please answer the below only a new student.
1) Have you ever learned Japanese before? If yes, how long have you learned?
2) How did you learn? (e.g., College, Language School, Online lesson...)
3) Which textbook did you use?
4) Are you confident to read and write HIRAGANA, KATAKANA, or any Kanji?
5) Have you ever tried JLPT? If yes, what level did you pass?
6) What is the purpose of learning Japanese?
7) How did you know about our school?
Additional Comments
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