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どちらの日程の国内留学に参加されますか?
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どちらのレベルに参加されますか?
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参加者氏名
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参加者氏名(カナ)
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参加者学年
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参加者の生年月日(西暦/月/日)
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性別
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住所
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電話番号(生徒が18歳未満の場合は保護者番号)
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メールアドレス(参加者が18歳以下の場合は保護者アドレス)
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保護者氏名(参加者が18歳以下の場合)
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保護者氏名(カナ)
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アレルギーや持病など、配慮すべき事項があればご記入ください。
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上記の質問で「ある」と答えた方は内容をご記入ください。
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緊急連絡先(電話番号)①
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緊急連絡先①と参加者の間柄
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緊急連絡先(電話番号)②
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緊急連絡先②と参加者の間柄
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現地への行き方についてお答えください。
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帰り方についてお答えください。
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プログラムはすべて参加できますか?(1日目午前10時~3日目午後4時まで)
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上記の質問で「いいえ」と答えた方はその詳細をご記入ください。
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今回の参加者は AHHA 9 Muscles English Clubに通われていまていますか?(メンバー割引あり)