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2019 YIS Summer Program Student Details
Please complete the following form for each child you are registering, which includes queries regarding medical history, supervised school excursion permission, lunch details, EAL needs, and photography permission.
Student's Given Name (First and Last) *
Your answer
Student's Date of Birth *
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YYYY
Medical Information
Nurses Contact Details (nurse@yis.ac.jp or 045-621-4027)
Emergency Contact Information (Please include name and phone number) *
Your answer
Does the student have any allergies? *
If yes, please answer the following questions below:
What is the allergen?
Your answer
What kind of allergic reaction does your child experience?
What medication does your child take in case of allergic reaction?
Where is your child's allergy medication kept while he/she is in school?
Does your child require special care or attention for his/her allergy condition by the school nurse?
Is there anything else that you would like to tell us about your child's allergy condition or treatment?
Your answer
Does the student have asthma?
How would you assess the severity of your child's asthma?
Does your child use an inhaler or nebulizer?
Where is your child's inhaler or other asthma medication kept while he/she is in school?
Does your child require special care or attention for asthma by the school nurse or other personnel?
Is there anything else that you would like to tell us about your child's asthma condition or treatment?
Your answer
Is the student currently being treated for any other medical condition? *
If yes, please specify below:
Your answer
Does the student take any medication on a regular basis? *
If yes, please specify below:
Your answer
I understand that in the event of a medical emergency involving my child named above, the school will make every effort to contact me and/or my spouse as quickly as possible. However, if urgent medical attention is required before contact can be made, I authorize the school to take appropriate medical measures, including, if deemed necessary, seeking attention from the nearest medical facility. *
Supervised School Excursion Permission
I give permission for my son/daughter to take part in supervised school trips off campus. *
Lunch Details (For High School and Middle School Students Only)
Please know that lunch is included in the fees for Elementary School
Will your child purchase lunch at school?
English as an Additional Language (EAL)
Would you like your son/daughter to be included in our EAL program? *
If yes, please assist us by letting us know their present level:
Media Release Agreement
I understand that YIS may take photos or videos over the course of summer program, which may appear in future school publications. (If there are any questions or concerns please contact our summer program coordinator at summer@yis.ac.jp)
How did you hear about our Summer Program??
Please Choose One of the Following *
THANK YOU FOR REGISTERING WITH YIS SUMMER PROGRAMS. WE LOOK FORWARD TO SEEING YOU THIS SUMMER
* Please fill out this form for each child registered for the YIS summer program. Click on the "submit another response" on the following page.
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