HAYAMA INTERNATIONAL SCHOOL

HOLIDAY PROGRAM

※This form is for Hayama Campus.

Student Information

Child's First Name 
Child's Last Name 
Child’s Birthday 
/ /
Blood Type (If known)
UnknownABOAB
Gender
MaleFemale
Nationality 
TEL 
FAX
Zip
Address
Name of School Attending
Grade
Allergy
First time?
YesNo
Medical history
投薬の必要性

Family Information (Emergency)

Full Name of Guardian1 
Relationship
Guardian1 Date of Birth
Guardian1/Mobile# 
Guardian1/Mobile E-Mail 
Guardian1/Occupation
Full Name of Guardian2
Relationship
Guardian2 Date of Birth
Guardian2/Mobile#
Guardian2/Mobile E-Mail
Guardian2/Occupation

Class Schedule

Session
Session1: ¥38,000
受ける受けない
Session2: ¥38,000
受ける受けない
Kindergarten or Elementary
KindergartenElementary
Academic/Fun Activity ※A student who was born before March 31st, 2013.
School Bus
session1:Disuse¥2,000¥3,000
session2:Disuse¥2,000¥3,000

※鎌倉方面で若宮大路(21号)又は、金沢街道より逗子側は2,000円になり、以外は3,000円となりますので場所の確認をされたい方はスクールまでお問い合わせ下さい。
School Lunch
session1:
nonebringing one's own lunch¥2,000(Kindergarten)¥2,400(Elementary)
session2:
nonebringing one's own lunch¥2,000(Kindergarten)¥2,400(Elementary)
Remarks
Route
¥2,000
Hayama
Zushi
Yokosuka
Kamakura
Yokosuka
(長坂・萩野・長井・武・平作・小矢部・池上・坂本・
汐見台・鶴が丘・林・阿部倉・太田和・金谷・衣笠栄町・
衣笠・平和台・逸見が丘・望洋台・御幸浜・山科台・山中町)

Kamakura
(材木座・大町・雪ノ下・JR鎌倉駅・十二所・浄明寺・二階堂)
Route
¥3,000
Kamakura
Fujisawa
Kanazawa-ku
Yokosuka
Others
Others

English Level Check

My child attends/has attends an
International SchoolESL Afterschool Program. ex:Eikaiwa
When?
My child can
ReadsWritesSpeaks English

Questionnaire

How have you found us? (You can choose multiple)
1.Facebook2.Flyer3.HP4.Search Engin5.School Bus6.Introduction7.Other
7.Otherを選択された方は、ご紹介者など具体的にご記入ください。

School Waivers & Agreements

With the exception of the “Photograph & Video Release”, all waivers & agreements MUST be signed/initialed in order for this application to be processed. No changes to the waivers & agreements will be accepted.

Other Fees

Parents need to pick-up their child on time at 3:00. There might be a late pick-up according to the supervisor on duty that evening, you will be expected to give that supervisor payment before leaving. If you are later than 90 minutes picking up your child(ren), we are required by law to call child protective services.

In case of Emergency

I understand every effort will be made to contact the parents/guardian or listed emergency contacts in case of an emergency. In the event I cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility. I also understand that I will be responsible for payments of any medical expenses incurred on my child’s behalf and that Hayama International School does not have funds available for payments of medical treatment for my child.

Photograph and Video Release

I hereby agree to grant my full and irrevocable consent to release any photographs and/or video footage to Hayama International School, for online album and art purposes in any medium publication or publicity, alone or in conjunction with the photographs or video footage of other persons objects or text material, and either with or without my name accompanying quotation.

Waiver

I understand that Hayama International School assumes no responsibility for injuries or illnesses which my child may sustain as a result of my child’s physical condition resulting from participation in any session activities, athletic activities, sports programs, the use of any equipment, exercise or other activities. I expressly acknowledge on behalf of myself and my heirs that I assume the risk for any and all injuries and illnesses, which may result from participation in these session activities. I hereby release and discharge Hayama International School, its agents, servants and employees from any and all claims for injury, illness, death, loss or damage, which my child may suffer as a result of my child’s participation in these activities. I understand that Hayama International School is not responsible for personal property lost or stolen while members and/or program participants are using Hayama International School facilities or on Hayama International School premises. I acknowledge the WAIVER set forth above.

REFUNDS AND CANCELLATION POLICY:


If fees have been paid and written a cancellation is made more than 10 days before the start of the session, the balance will be returned less a registration cancellation fee (¥10,000). If fees have been paid but a written cancellation is made less than 10 days before the start of the session, no fees will be returned. If the school was closed because of school holidays, please make sure to leave a message or send an e-mail for your cancelation. The office opens at 9:00am. If you wish to contact the school from 6:00pm to 9:00am on weekdays or Saturday and Sunday, please send a text message to (contact@hayama-international.co.jp.)

Bank transfer fee is paid by applicant.

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