2017 Winter Program Final Registration Form (submission deadline December 1st)
Please complete an additional form if you have more than one child participating in the Winter Program.
We are providing limited bus services from Jeongja, Pangyo and Yatap.
The cost of the program is 400 000won without busing, and 480 000won with busing. This includes snacks, lunches, a t-shirt and 5 days of fun.
All payments of tuition and fees are non-refundable.
Please remember only 20 students from K-1, 20 students from 2-3 and 20 students from 4-5 will be accepted in our inaugural year.
The Winter Program will run from December 18th to December 22nd from 9:00-3:30pm at KIS Pangyo.
If you have any questions or concerns, please e-mail at phill@kis.or.kr
Email address *
Student name (full name as shown on passport) *
Your answer
Student number *
Your answer
Date of birth (MM/DD/YYYY) *
Your answer
Campus Enrolled *
2017-2018 Grade Level and class *
Student Gender *
T-Shirt size *
Parent/Guardian name
Your answer
Primary Phone Number (000-0000-0000, Please do type dash between the numbers) *
Your answer
Alternate Phone Number (000-0000-0000, Please do type dash between the numbers) *
Your answer
Parent E-mail Address *
Your answer
Physical Address *
Your answer
Alternative Emergency Contact Person *
Your answer
What subway station is closest to you home? *
Your answer
Will you use our bus service? *
If yes, which station station will you use?
Please rate your child's swimming ability *
Does your child have any medical condition/s or limitation/s (physical or emotional) that may necessitate care, affect their well-being or the well-being of others, or affect their ability to participate in summer program activities? *
If "YES" please explain
Your answer
I understand that the above information is correct by indicating yes below *
Type your full name below for your electronic signature. *
Your answer
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