2016 Summer School Enrolment
Student Details
Student Name (#1)
*
Date of Birth (#1)
*
-
Month
-
Day
Year
Age (#1)
*
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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Student's (#1) Current School:
*
Has Student (#1) attended TIS Summer School before?
*
Yes
No
Student Photo (attach a file) #1
*
Student Name (#2)
Date of Birth (#2)
-
Month
-
Day
Year
Age (#2)
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
--
Student's (#2) Current School:
Has Student (#2) attended TIS Summer School before?
Yes
No
Student Photo (attach a file) #2
Have you or your children lived overseas before?
*
Yes - Parents have lived overseas
Yes - Children and Parents have lived overseas
No
If Yes, please explain.
*
Briefly explain student(s) experience with academic English education to date.
*
How did you learn about TIS summer school?
Website
Flyer
Other option
School Lunch Needed:
*
Yes (3600円)
No
School Bus Needed:
*
Yes
No
Bus Stop
------ Bus Route A ------
Daikannon Mae (2000円)
Chomeigaoka 6 Chome Minami (3000円)
Chomeigaoka 1 Chome Higashi (3000円)
Kamo 4 Chome Minami (3000円)
Yaotome Station (3000円)
Kitane 1 Chome (3000円)
Kita-Yonbancho (4000円)
Sendai Station (4000円)
------ Bus Route B ------
Teraoka (3000円)
Tapio (3000円)
Takamori Pump-Jo (3000円)
Takamori 5 Chome (3000円)
Katsura 3 Chome (3000円)
Akaishidai 3 Chome (3000円)
Home Address
*
Phone
*
Parent Contact Information
Mother's Name
*
Mobile
E-Mail
*
Employer
*
Father's Name
*
Mobile
E-Mail
*
Employer
*
Emergency Contact
(in case parent cannot be reached)
Name
*
Relationship
Phone
*
Your name below verifies that you accept the Summer School program times and schedules.
Name of Parent or Legal Guardian
*
E-Mail Address for Confirmation
*
Submit
Should be Empty: