2015 MSTERIO Int'l Summer Camp
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
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 *
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?
その他・連絡事項など/ Remarks・Comments
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