AJE Spring Camp 2017 - Aoba-Japan International School

2017
SPRING
ADVENTURE
CAMP
Trees, Tents, Fields, and Friends
AJE is proud to announce the latest camp experience
for kids and teens, and this one is dedicated to the
great outdoors! Join us for a one week experience
learning about the wonders of nature!
From March 27 to March 31, 2017, we will be taking
the participants of the AJE Spring Adventure Camp to
Forest Village in Midori, Chiba. Midori is located in
the center of the Boso Peninsula in the south-central
part of Chiba Prefecture. It is a safe and scenic area,
surrounded by nature all around.
1
Discover Nature
2
Experience Adventure
When adults are asked to recall a time in
their youth when they were happiest,
invariably they refer to times spent
outdoors and with friends. Our clever
screen world keeps us busy and on the
go, but does not help us to communicate,
feel loved, gain the satisfaction of the
quiet mind, and relax. Time with others
in nature does exactly that -- and much,
much more!
Adventures in nature have a very positive
effect on health and mind. Natural
surroundings give us the opportunity to
learn more about who we are. We must
rely on our senses, on our mobility, and
on the opportunity to engage in activity
that is not based on the intentions of
others. Adventures in nature allow
people to learn about natural settings,
risk, challenge, uncertainty, teamwork,
and self-sufficiency—indeed, they are
challenged to learn about themselves.
3
Cooperate, Collaborate, Lead
Engaging in natural environments helps grow our self esteem, our sense
of responsibility, and our ability to respect the needs of others. It
increases our personal horizons and helps us gain greater appreciation
and understanding for the world and those around us. We grow to better
understand the need the relationships between us and our environment.
We increase our abilities in practical problem solving and team work.
We allow the opinions of others to guide us, and in turn we help guide
them with our own.
4
Learn Independence
The AJE Spring Adventure Camp gives AJE campers the ability to
enhance their learning through interaction with nature. Outdoor discoveries, imaginary play, exploration, nature, and science, spaces for
climbing, crouching, rolling, mixing, painting, and building all allow
children to be safe to do, rather than safe from doing.
Forest Village is a full-service facility set in a natural
and green wilderness environment. It has a lodge,
campsites, forests, fields, and everything we need to
help your children participate in exciting outdoor
experiences.
Who’s Going, & When?
Age Range: 6-17
1 Week: March 27 to March 31, 2017
How Much Does it Cost?
Local Students (residents of Japan)
Registration
¥15,000
1 Week
¥100,000
International Students (non-residents of Japan)
Registration
1 Week
¥25,000
¥125,000
*AJE staff supervise students 24 hours per day.
*Sales tax of 8% will be added to the total fees.
*Fees are inclusive of all costs.
長柄町
千葉
AJE reserves the right to make changes to programs when required.
AJE Extension Programs
2017
Registration Form
¢ PERSONAL INFORMATION 生徒情報 (個人情報)
Family Name 姓
First Name 名
Age 歳
Grade 学年
Birthdate 誕生日: _______ (M/月) _______ (D/日) ________ (Y/年)
*For Office Use Only
A-JIS Student?
Returnee? 元アオバ生徒
☐ Yes ☐ No
☐ Yes ☐ No
Other/Middle ミドルネーム等 :
A-JIS Student Number:
AJE Student Number:
¢ ADDRESS 住所
Street Address 住所:
City 市:
State/Province/Prefecture 県:
District/Ward 区:
Country 国:
_______________________________________________
_______________________________________________
〶
_______________________________________________
\
HOME PHONE NUMBER 電話番号
MOBILE PHONE NUMBER 携帯電話番号
Postal
Code
EMAIL ADDRESS (PC Address) パソコンメールアドレス
¢ AJE CAMPS キャンプ (Summer, Fall, Winter, Spring, Sports, Beach, and More!)
¢
NOTES 注意
¢
• Winter, Fall, Spring, & Sports
Camps are 1 week only.
• From 1 to 5 weeks are available
for the Summer Camp.
• Camps (unless specified) run
Mon. to Fri., 09:00 to 16:30.
• 8% Tax is added to all fees paid.
• 1 Week = 5 days (Mon-Fri).
Additional days ¥20,000.
• 冬秋春季、及びスポーツキャン
プは 1 週間のみ。
• サマーキャンプは 1 週間から 5
週間で選択可。
• キャンプは特に指定がなければ
月〜金の 9 時から 4 時半まで。
• 8%消費税が別途かかります。
• 1 Week の費用は月〜金の 5 日
間分です。1 日増えるごとに
20,000 円が追加されます。
☐
☐
☐
☐
☐
¢
¢
BASIC CAMP FEES キャンプ意
1 WEEK (5 days)
2 WEEKS
3 WEEKS
4 WEEKS
5 WEEKS
¥100,000
¥150,000
¥200,000
¥250,000
¥300,000
SELECT YOUR START AND END DATES
開始日と終了日をお選びください.
Week 1
Week 2
Week 3
Week 4
Week 5
Summer Camp
☐
☐
☐
☐
☐
Mon. July 17
Mon. July 24
Mon. Jul. 31
Mon. Aug. 7
Mon. Aug.14
to
to
to
to
to
☐
☐
☐
☐
☐
Fri. July 21, 2017
Fri. July 28, 2017
Fri. Aug. 4, 2017
Fri. Aug. 11, 2017
Fri. Aug. 18, 2017
ADDITIONAL FEES 及び追加意の費用:
Day Rate 1 日につき
¢
¥20,000
Includes day program costs: instruction, materials lunch, local
curricular transportation (not including morning/afternoon bus
service to/from school).
MORE CAMPS 及び追加キャンプ
Mid Winter Sports
4 Days
☐ Wed. Feb. 15
to
☐ Sat. Feb 18, 2017
Spring Camp
レッスン指導料、材料費、昼食費、都内交通費などのデー・プロ
グラムの費用を含む。
1 Week
☐ Mon. Mar. 27
to
☐ Fri. Mar.31, 2017
Beach Clinic
3 Days
☐ Sat. Jun. 17
to
☐ Sun. Jun.18, 2017
Extended Services 1 日につき
Fall Camp
1 Week
☐ Mon. Oct. 9
to
☐ Fri. Oct.13, 2017
Winter Camp
5 Days
☐ Tues. Jan. 2
to
☐ Sat. Jan. 6, 2018
¥5,000
For extended travel and specialized activities: i.e. rentals and
accommodations at ski resorts.
例えばスキートリップの用具レンタル、宿泊費など、旅行や遠足
などにかかる費用。
Have you ever
joined an AJE
Camp before?
What Year?
何年に？
☐ Yes
☐ No
AJE キャンプに参加し
たことはありますか？
☐ 2017
☐ 2016
☐ 2015
☐ 2014
☐ 2013
☐ INTERNATIONAL STUDENT FEE: (Do you have a permanent Japanese address?)
Which Camp?
どのキャンプに？
☐ Yes ☐ No
☐
☐
☐
☐
☐
☐
Summer
Fall
Winter
Spring
Dance
Other: ________
If “NO” add ¥25,000
海外からの参加者（日本の永住権がありますか？）
☐ REGISTRATION FEE 登録費
☐ ¥15,000/year
TOTAL FEES
Waived for A-JIS Students. A-JIS の在校生は入学金が免除さ
れます。
¥ ___ , _____
¢ Refunds
Refunds: The Admissions Office will refund tuition only following receipt of written notification by particular times.
Tuition: Tuition Fee is refunded according to the following notification dates prior to the start of the programs.
- 43+ days prior to the date of entry: 100% Refundable
- 42 days prior to the date of entry: 70% Refundable
- 28 days prior to the date of entry: 50% Refundable
- Within 14 days of the date of entry: No Refund
Registration, Books and Material Fees, and Student Services Fees: Non-refundable.
参加費用等の返金について：納入後、参加を辞退する場合は、書面での通知を学校が受理した後、下記のとおり返金致します
参加費：参加費はプログラム開始前の下記の通知日によって返金いたします。
- 初参加予定日の前日から起算し遡って 43+日以前の解約 100%返金 -初参加予定日の前日から起算し遡って 42 日以前の解約 70%返金
- 初参加予定日の前日から起算し遡って 28 日以前の解約 50%返金 -初参加予定日の前日から起算し遡って 14 日以降の解約返金なし
登録費、教科書代、教材代、スチューデントサービス費は返金いたしません。
☐ YEAR/MONTH/DATE 年/月/日
年
Revised Jan. 11, 2017
☐
月
日
X
SIGNATURE 署名
Personality Questionnaire 質問書
Please complete this form in English
全て英語でご記入ください FAMILY NAME 姓
FIRST 名 MIDDLE  Please describe your child’s personality. お子様の性格をお書き下さい。
 What are your child’s strengths and weaknesses? お子様の長所と短所はどのようなところですか？
 What aspects of school are most important to your family?
学校のどのような面があなたの家族にとってもっとも大切だとお考えですか？
 Why do you wish to attend an international summer camp? Why did you choose AJE?
なぜインターナショナルスクールへの入学を希望したのですか？なぜ A-JIS を選んだのですか？
1
Form D Questionnaire Form 10-March-2011
Health Form 生徒の保健書類
Please complete this form in English 全て英語でご記入ください。
 Student Personal Information 生徒の個人情報
FAMILY NAME 姓
FIRST 名 MIDDLE DATE OF BIRTH 生年月日
GRADE 学年
 Male 男
MM 月 DD 日  Female 女
YYYY 年  Health History 健康の記録
Please indicate if your child has experienced any of the following. 現在または、以前において以下の項目に該当する場合は□にチェックをお願いします。
A. KNOWN MEDICAL CONDITIONS 病歴など
B.DIFFICULTY/ SPECIAL NEEDS 障害/特別な援助
 ASTHMA 喘息
 VISION 視覚
 ATOPIC DERMATITIS アトピー性皮膚炎
 HEARING 聴覚
 DRUG ALLERGIES 薬剤アレルギー
 SPEECH 発語
 FOOD ALLERGIES 食品アレルギー
 PHYSICAL MOVEMENT 身体的動作
 OTHER ALLERGIES その他アレルギー
 LEARNING DISABILITY 学習障害
 ADD / ADHD 注意欠陥・多動性障害
 EMOTIONAL / BEHAVIORAL 感情/行動
 HEART DISEASE 心臓疾患
 SOCIAL 社会性
 DIABETES 糖尿病
 FOCUS / ATTENTION 集中力/注意力  SEIZURES てんかん
 COGNITIVE 認識能力  CONGENITAL ANOMALIES 先天異常  GIFTED / TALENTED 特殊な才能を持つ C. SUPPORT PROGRAM/SERVICES
サポートプログラム/サービス
 PSYCHIATRIST 精神科医
 PSYCHOLOGIST 心理学者
 COUNSELING カウンセリング
 LEARNING SUPPORT 学習支援
 SPEECH THERAPY スピーチセラピー
 PHYSICAL THERAPY 理学療法
 OCCUPATIONAL THERAPY 作業療法
 IEP (INDIVIDUAL EDUCATIONAL PROGRAM) 個人教育プログラム
 OTHER その他
 RECENT MAJOR SURGURY, SERIOUS INJURY
大きな手術または負傷
If you selected any of the above categories, please provide details of conditions, effects, limitations, medications and treatments. Attach additional documents if
necessary. 上記のいずれかを選択した場合は、現在の状況、影響、制約、投薬、や治療内容の詳細をお知らせ下さい。必要に応じて関連資料を添付して下さい。
 Current Medications 常用薬
Please list any medications your child is currently taking. お子様が現在服用しているすべての薬をご記入下さい。
NAME OF MEDICINE 薬品名
REASON 理由
DOSAGE & FREQUENCY 用量＆頻度
POTENTIAL SIDE EFFECTS
副作用の可能性
Form C Health Form 10-March-2011
2
 Declaration 確認
I certify that the information provided in this form is complete and accurate. I
understand that withholding information concerning my child’s health and wellbeing will entitle the school to deny enrollment. I understand that following
enrollment, academic, behavioral or social assessments will be undertaken as
needed. If the assessment results show a possible educational learning disorder,
the school reserves the right to ask the parents/guardians to take the student for
further testing. Should the parents/guardians refuse the testing, and or additional
tests diagnose a learning deficit that cannot be addressed by the school, the
student may be removed from A-JIS and advised to be placed in a school that
would be more appropriate in handling the students needs. I understand that in the
event that a parent or guardian cannot be reached in order to provide consent for
emergency medical treatment, I consent to providing the school with authorization
to seek medical treatment while participating in school-related activities.
SIGNATURE OF PARENT GUARDIAN
保護者署名
保健医療に関する合意書：上記に記載されている内容は正確であり記入漏れがない
ことを誓います。私の子供の健康/身体について情報を隠すことは、学校が入学を
断る理由に値すると理解します。入学後、必要に応じて学力、態度、または社会性
が評価されることを理解します。もし評価の結果、学習障害の可能性が見られた場
合は、学校は更なる検査を受けに行くことを保護者に要求する権利があります。保
護者がこの要求に応じない場合、または検査の結果、学校では対応できない学習障
害があると診断された場合は、本校ではなくその生徒に適した学校に転校してもら
うことになります。私の子供が在校中に受けた負傷、または発病で緊急治療を要す
る場合、保護者と連絡が取れない時はジャパンインターナショナルスクールが緊
急時の適切な医療措置をとることを認め学校に責任は問いません。 DATE
日付
Form C Health Form 10-March-2011
Dietary Restriction Form 食事制限確認書
3 Please complete this form in English 全て英語でご記入ください。
 Student Name 生徒氏名
FAMILY NAME 姓
FIRST 名 MIDDLE  Dietary Restrictions
DOES YOUR CHILD HAVE ANY DIETRY
RESTRICTIONS? お子様に食事制限はありますか？
 NO いいえ  YES (please specify below) はい(詳細を以下に)  Religious Restrictions, Family Policy 宗教上の理由／家庭の方針による制限
RESTRICTED FOODS & DRINKS
宗教上の理由／家庭の方針により私の子供は下記の食べ物/飲み物を制限しています。  Medical Restrictions 健康上の理由(アレルギーなど)による制限
RESTRICTED FOODS & DRINKS
健康上(アレルギーなど)の理由により私の子供は下記の食べ物/飲み物を制限しています。 CONSEQUENCES OF CONSUMPTION
それを飲食した場合、どのような反応が起きえますか？または起きましたか？  Other Requests
If there is any concern or request regarding our school lunch program, please list them below:
スクールランチに関するご意見やご要望があればこちらにお書き下さい。
 Declaration 確認
SIGNATURE OF PARENT GUARDIAN
保護者署名
DATE
日付
Form C Health Form 10-March-2011
2017 Camp Permission Reply Slip
(Please attach Medical Insurance Certificate to the back)
My son/daughter will be attending the AJE _____________ Camp from ____________________ to ________________________.
I understand that this trip is an optional program provided by the AJ Extension division of Aoba-Japan International School
and is open to all students from ages 5 to 17.
I hereby grant permission for my child_________________________________(student name) to participate in a field trip to:
_____________________________________________________ (Name of Location).
Food allergies or special accommodations needed: (Please write specifically)
_________________________________, ___________________________________, __________________________________
Field Trip/Excursion Description
I understand that all students participating in this trip will be responsible in conduct to the driver and to the teachers or
adult sponsors at all times. It is further understood that all field trips will begin and end at school and that students are
required to go and return from this event on the transportation provided.
As the parent/guardian of the above named student, I have read the field trip itinerary and I understand that there are risks of
physical injury associated with the participation in these activities.
I authorize qualified emergency medical professionals to examine and in the event of injury or serious illness, administer
emergency care to the above name student. I understand every effort will be made to contact me to explain the nature of the
problem prior to any involved treatment. In the event it becomes necessary for school staff-in-charge to obtain emergency
care for my student, neither he/she nor the school assumes financial liability for expenses incurred because of the accident,
injury, illness and/or unforeseen circumstances.
These activities are an extension of the school education program and student conduct is to be in accordance with the school's
published rules and regulations.
Parent/Guardian Signature: ____________________________________ Date: ____________________________________________
Best number to be reached at in case of emergency:
Alternate emergency number: ________________________________________________________________________________
I pledge that my conduct will, at all times, reflect upon myself, my parents, and my school. I understand that the school rules of
conduct apply while on the trip.
Student Signature: ________________________________________ Date: _________________________________________________
Students Name: ________________________________________ Homeroom Class: ________________________________________

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