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2015 MSTERIO Int'l Summer Camp
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* Indicates required question
お子様の名前/ Applicant's Name
*
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お名前ふりがな/ Japanese Name Only
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お名前の英語表記/ Applicant's Name in English
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生年月日/Date of Birth
*
月/日/年 (mm/dd/yyyy)
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年齢/ Age
*
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学年(申込の時点で）/ Grade at the time of application
*
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性別/ Gender
女/ Female
男/ Male
郵便番号/ Zip Code
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住所/ Address
*
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固定電話番号/House Phone # if any
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保護者氏名（母親）/ Name of Mother
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保護者氏名（父親）/ Name of Father
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親以外の保護者/Name of Guardian
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保護者Emailアドレス/ Email Address
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ミステリオではメールが主な通信手段となります。添付資料も多くありますので、可能な限りPCメールアドレスをご記入下さい。Please indicate your email address you will use frequently as email will be the main method of communication in MSTERIO.
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保護者携帯電話番号/ Cell Phone # (Parents')
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保護者携帯アドレス/ Cell Phone Mail Address if any
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重篤なアレルギーや持病をお持ちの方、または各種Special Education Serviceを受けている場合には簡単にご記入下さい。
If your child has any special needs such as serious food allergy, chronic disease or receiving special education services, please briefly indicate here.
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＊初参加の方のみ。どうやってミステリオをお知りになりましたか？/ For first time applicants only: How did you know about MSTERIO?
新聞
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インターネット
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その他・連絡事項など/ Remarks・Comments
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