Summer School Application Form for Preschool-Kindergarten-Primary Students
Dear parents,

Thank you for your interest in our Summer School Programme.

Please fill out the form below and submit it to apply for the Summer School.

Please contact the school office at shibuya@jies.jp for any questions you may have.

Looking forward to having your child at our Summer School.

SIS

Student Information
Please enter information about your child.

If you are applying for more than 1 child, please apply separately.

Student Name *
First-Middle-Family Names of your child.
Gender *
Please select your child's gender from the list below.
Birth Date *
Please enter your child's date of birth.
MM
/
DD
/
YYYY
Nationality *
Please list ALL the nationalities your child holds.
Is your child currently enrolled at Jingumae? *
School
Please enter your child's current school if it is different than Jingumae!
Grade/Class *
Please select your child's current grade/class at their school.
Languages *
Please list the languages your child can communicate in, starting with the most competent.
Experience in English *
Indicate how many years of experience your child has in an English speaking environment. Please keep in mind that we will have native Japanese speakers to help students throughout the program but our main instructors are native English speakers.
Allergies and Restrictions
Please enter the allergy and food restrictions your child has.
Photo Upload *
Please upload your child's photo.
Required
The Legal Guardian
Please enter the necessary legal guardian information below.
Name *
Please enter the name of the legal guardian making the official application.
Relationship *
Please enter the relationship between the child and the legal guardian.
Nationality of the Guardian *
Please list the nationalities the legal guardian holds.
Home Address *
Please enter the home address.
Phone Number
Please enter the legal guardian's landline phone number.
Mobile Phone Number *
Please type the mobile phone number of the child's guardian.
Email Address *
Please enter 1 email address you would like the summer school related emails to be sent to. JIES parents should enter their JIES email addresses.
Emergency Contact Name *
Emergency Contact Mobile Number *
In case you can't be reached for an emergency, this person will be contacted.
Application Information
Please enter the information regarding your application.
Tuition for Each Session – 40,000 JPY (Including Tax).
For JIES Students – 30,000 JPY (Including Tax)

SESSIONS:
Session 1: Monday July 9 - Friday July 13
Session 2: Monday July 16 - Friday Jul 20
Session 3: Monday July 23 - Friday July 27
Session 4: Monday July 30 - Friday Aug 3

Summer School Sessions *
Please indicate whether you would like to enroll your child for EACH SESSION!
YES, Enroll my child!
NO, I don't want to enroll!
Session 1
Session 2
Session 3
Session 4
Photo/Video Release *
Please indicate which of the following you would like to authorize JIES to use your child's photo/video.
Required
Student Dismissal *
Students attending preschool or kindergarten will not be allowed to go home on his/her own from school.
Pickup Person
If your child is picked up after school, please type the person's name and relationship. Ex: PARENT- Tarao, Babysitter - Suzuki.
Remarks
Please type your comments here.
Submit
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