REGISTRATION FORM - Hand In Hand International School & Child

2-99 Motomachi, Naka-ku, Yokohama, Japan 231-0861
Tel: 045-228-8090 Email: [email protected]
REGISTRATION FORM
Summer School 2015
サマースクール申込書
Child’s Name:
Age:
First
参加者氏名
Date of Birth:
/
mm
生年月日
Last
Current Grade or in Fall 2015:
/
dd
年齢
yyyy
学年
Home Address:
自宅住所
Name of school currently enrolled:
在籍している学校名
Please put a
☑ next to applicable box(es).
該当する箇所すべてにチェックを入れてください。
English level of proficiency:
None
Limited
Basic
Intermediate
Fluent / Native
英語力
なし
少し
初級
中級
上級
Does your child have any medical or physical conditions (allergies, diabetes, asthma, epilepsy, etc.) diagnosed or otherwise?
身体や健康状態に異常はありますか？（アレルギー、癲癇、喘息など）
Yes
No
If yes, please provide details.
I give permission for my child to walk home alone after program ends.
Yes
No
保護者の付き添いなしで、お子様一人での帰宅を許可しますか？
PROGRAMS AND SESSIONS
□Session 1 (7/6-7/10) □Session 2 (7/13-7/17)
① SUMMER FUN Ages 3.5 to 6
¥45,000 per session, 9:00-2:30 M-F
□Session 3 (7/20-7/24) □Session 4 (7/27-7/31) □Session 5 (8/3-8/7)
□Session 6 (8/10-8/14) □Session 7 (8/17-8/21)
□Optional School Lunch for _____session(s) / ¥1,500 per session
ITEMS TO BRING:
**Not available for Session 6
Indoor shoes, lunch, cutlery, water filled drink bottle with strap, change of clothes, hand towel, hat
上履き、ランチ、フォークセット、ストラップが付いた水筒（水又はお茶）、着替え、ハンドタオル、帽子
② DAY CAMP Ages 7 to 10
□Session 1 (7/27-7/31)
¥50,000 per session, 9:00-2:30 M-F
□Session 3 (8/10-8/14)
□Optional School Lunch for _____session(s) / ¥1,500 per session
ITEMS TO BRING:
□Session 2 (8/3-8/7)
**Not available for Session 3
Indoor shoes, writing tools, lunch, cutlery, water filled drink bottle, hand towel, hat
上履き、筆記用具、ランチ、フォークセット、水筒（水又はお茶）、ハンドタオル、帽子
③ LITERACY WORKSHOP Ages 5 to 10
¥65,000 per session, 9:30-12:00 M-F
ITEMS TO BRING:
□Session 1 (7/6-7/17)
□Session 2 (7/20-7/31)
Writing tools and notebook
筆記用具、ノート
PLEASE TURN OVER
Summer Registration Form
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□EARLY REGISTRATION DISCOUNT早期申込割引
(5% by May 22, 2015)
□MULTIPLE SESSION DISCOUNT
回数割引
(Register for more than one session in any program to receive 5,000 yen discount per session.)
□GROUP DISCOUNT
グループ割引_____________________________________________________________________ fill in name(s)
(Register together with a sibling or friend to receive 3,000 yen discount per child.)
Terms and Conditions of Participation
参加の条件
•HIH reserves the right to cancel classes, or to alter timetabled activities due to unforeseen circumstances or health and safety issues.
•The parent will permit first aid to be administered to their child by a suitably qualified member of staff where considered necessary. The
parent furthermore authorizes a qualified medical practitioner to provide emergency treatment or medication if necessary.
•HIH will use photographs taken during summer school for promotional purposes.
•HIH will not be held responsible for any accidents, injuries or damages that may occur during summer school.
•Your child should wear suitable comfortable clothing and non-slip shoes.
•Participants arrive and depart within 5 minute period of program start and end time. There will be additional charges for early arrival and
late departures that go over this grace period.
•By the attendance of your child at Hand In Hand Summer School will be regarded as evidence of acceptance of, and consent to, these
conditions.
Payment & Refund Policy
支払と返金制度
•Registration will not be complete without payment of fees by the deadline indicated on the invoice.
•No refund or make-up days will be given if participant cancels or misses days for any reason.
•HIH reserves the right to cancel a session with a full refund if minimum enrollment (5 participants) is not met or due to teacher absence.
•No refund will be given if HIH cancel classes, or alter timetabled activities due to unforeseen circumstances or health and safety issues.
※All fees must be paid in the child’s name. お子様のお名前でお振込み頂きますようお願い致します。
Please make payment to:
振込先：
Bank of Yokohama, Motomachi Branch
横浜銀行元町支店
Ordinary Account: 6025793
普通預金：6025793
Account Holder: Hand in Hand - CDC
口座名義：ハンドインハンド
I hereby register my child in HIH Summer School 2015. I have read and will comply with the policy and conditions.
参加の条件と支払返金制度等をすべて了承の上、上記の通りHIHサマースクール2015に申し込みます。
Parent’s Name:
Date::
保護者氏
日付
Home Tel:
Mobile:
自宅ご連絡先
携帯
Notices, emergency alerts, invoices, and all other forms of written communication are sent to parents by email.
保護者へのお知らせ、緊急通知、請求書などはＥメールでご連絡させて頂きます。
E-mail:
Please fill out and send this completed form to [ HIH Admissions] by mail, email or give it to us in-person by the registration deadline.
申込締切日までにこちらの申込書にご記入の上、[サマースクール係]宛てにご持参又は郵送、Eメールのいずれかでご提出下さい。
Hand In Hand International School & Child Care
EMAIL: [email protected]
2-99 Motomachi, Naka-ku, Yokohama, 231-0861
TEL: 045-228-8090 (M-F 9:00am – 3:00pm)
Summer Registration Form
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