Long Beach Japanese Language School Registration Form
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Full Name (Last, First, Middle)
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Email
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Date of Birth (mm/dd/yy)
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Sex (F or M)
Home Address (Street, Apt #)
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City
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Zipcode
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Phone number (primary)
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Phone number (other)
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Emergency Contact (name, phone, relation)
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Parent or Guardian
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Name of High School / College
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Have you studied Japanese?
If yes, (1) How Long, (2) School name (3) When
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How did you hear about us?
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