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
Student name (full name as shown on passport)
Date of birth (MM/DD/YYYY)
2017-2018 Grade Level and class
student small (100-120cm)
student medium (120-140cm)
student large (140-160cm)
adult small (155-165cm)
Primary Phone Number (000-0000-0000, Please do type dash between the numbers)
Alternate Phone Number (000-0000-0000, Please do type dash between the numbers)
Parent E-mail Address
Alternative Emergency Contact Person
What subway station is closest to you home?
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
I understand that the above information is correct by indicating yes below
Type your full name below for your electronic signature.
Send me a copy of my responses.
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