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The form records student identity information, parent/guardian contact details, relatives in Japan (if applicable), visa status, study history, current Japanese proficiency (Hiragana/Katakana/Kanji, JLPT, CEFR), and any pre-existing illnesses. It also requests permissions for minor medication, emergency treatment consent, dietary needs and allergies, travel arrival/departure logistics, how the school was found, publicity photo/video consent, and a structured refund policy timeline.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/summer-teen-program-application-and-parentguardian-consent-form-enrollment-paperwork/507356/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/summer-teen-program-application-and-parentguardian-consent-form-enrollment-paperwork/507356.png","ImageObject",300,407,{"name":92,"@type":93},"miaandmiso","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-05",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What information is collected for the student and parents/guardians?","Question",{"text":112,"@type":113},"The form collects the student’s family name, given name, kanji, birth date, gender, nationality, and optional fields such as religion and mother language. It also records parent/guardian name, relationship, address, and contact numbers (TEL/FAX, mobile) and e-mail.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What permissions are requested for health and emergencies?",{"text":117,"@type":113},"Parents/guardians grant permission for non-prescription medicines for minor pain or illness, and permission for the Course Director to sign necessary consent forms in case of emergency operation. The form also asks about pre-existing illnesses or conditions to help with preparation.",{"name":119,"@type":110,"acceptedAnswer":120},"How is the refund handled when a course is cancelled?",{"text":121,"@type":113},"A full course fee is refunded if cancellation is made before the application deadline. After the deadline, a cancellation fee applies based on the cancellation date (ranging from 20% up to 100% from July 11 onward). Natural-disaster-related lesson cancellations are replaced with assignments and no refund is made for those lessons.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},507356,1791513170,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},7971478544854,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Summer Teen Program Application and Parent/Guardian Consent Form  \n(Intended ages: 13~17 years old Date: 07/13/2025~07/27/2025)  \nThis application form is be filled out and signed by the parent, or guardian, of the student who is interested in enrolling in the Summer Teen Program. The information provided here will only be used for admission and class management, and will not be transferred to any third party.  \n 1. Student Information（学生情報）  \nFamily name  \nGiven name  \nKanji  \n\n| Alphabet |\n| --- |\n| Kanji |\n| Alphabet |\n\nDate of Birth (M/D/Y) Age Gender  \n□ Male □ Female  \n□ Other ( )  \n\n| Nationality Mother Language Religion (Optional) |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| 2. Parent/Guardian information（保護者の情報）\u003Cbr>Name Relationship Address |  |  |  |  |  |  |  |\n| TEL/FAX |  |  | Mobile e-mail |  |  |  |  |\n| 3. Relativeʼs contact information\u003Cbr>Name |  |  | in Japan, if applicable（日本の親族の連絡先）\u003Cbr>Address |  |  |  |  |\n| TEL/FAX |  |  | Mobile e-mail |  |  |  |  |\n| Residence\u003Cbr>Card Number Type of Visa |  |  |  |  |  |  |  |\n| 4. Visa(ビザ) |  |  |  |  |  |  |  |\n| Status □ Obtained □ Will obtain |  |  | Date of entry in Japan (intended) (M/D/Y) |  | Date of Expiration (M/D/Y) |  |  |\n| Type | □ Temporary Visitor □ Dependent □ Other( ) |  |  |  |  |  |  |\n| 5. Has Type of Study | your child studied Japanese?（日本語学習歴はありますか?) □ Yes □ No |  |  |  |  |  |  |\n|  | □ High School\u003Cbr>□ Self Study | □ Language School\u003Cbr>□ Other( |  | □ Private Lesson\u003Cbr>) |  | School name |  |\n| How long? year(s) month(s) About hours in total |  |  |  |  | Name of textbooks\u003Cbr>used |  |  |\n| □ Japanese Language(s) used in |  |  |  |  |  |  |  |\n| The teacher was？ □ Non-Japanese Nationality ( ) classroom |  |  |  |  |  |  |  |\n| 6. Your childʼs current Japanese level（日本語能力について) Your child can read and write □ Hiragana □ Katakana |  |  |  |  | □ Kanji ( |  | ) characters |\n| Japanese Language Proficiency Test (JLPT) Passed in (year) |  |  |  |  | □ N5 □ N4 |  | □ N3 □ N2 □ N1 |\n| CEFR |  |  |  |  | □ A1 □ A2 |  | □ B1 □ B2 |\n\n 7. Pre-existing illness or condition（既往症）  \nCheck boxes that apply □ N/A □ Learning Disabilities(□ Literacy □ Dyslexia □ ADHD □ Other LD）  \n□ Depression □ Epilepsy □ Panic Disorder □ Asthma □ Sleep Disorder  \n□ Other( ) Note: This question is to assist the school in making the necessary preparation, and will not affect your childʼs enrollment.  \n\n| 8. In case of minor pain or illness（軽症時の対応）\u003Cbr>In the case of minor pain or illness such as headache, mild cold or sore throat, do you permit the school to give your child non\u003Cbr>prescription medicine such as pain medicine, cold medicine, cough medicine, cough drops, anti-histamines and travel sickness tablets?\u003Cbr>□ Yes □ No |\n| --- |\n| 9. Emergency Hospital Treatment（緊急時の対応）\u003Cbr>In the case of emergency, every effort will be made to contact you, the childʼs parents/guardians, as quickly as possible. If your child needs an emergency operation, do you give permission for the Course Director to sign the necessary consent form?\u003Cbr>□ Yes □ No |\n| 10. Foods and Dietary Needs（食事について)\u003Cbr>Does your child require a special diet? Is your child allergic to any foods, or any food that can't be eaten for religious reasons?\u003Cbr>□ No □ Yes (Please specify in the blank below.) |\n\n 11. Any other information regarding your childʼs health（健康についてのその他の情報）  \nIs there any other information we need to ensure the health and well-being of your child? This information will be treated as confidential. Please specify in the blank below if any.  \n\n|  12. Student Travel Details（旅行情報） *Designated Arrival Time: 07/13 (Sunday) at 12pm~4pm (Arriving outside of the designated times may incur fees)\u003Cbr>Arrival Flight Number: Arrival Date: Time:\u003Cbr>Departing from: Arriving at:\u003Cbr>Departure Flight Number: Departure Date: Time:\u003Cbr>Departing from: Arriving at:\u003Cbr>Is your child registered with the airline as an Unaccompanied Minor? □ Yes □ No |  |\n| --- | --- |\n| 13. How did you hear about our school?","cbCaill9SfNzWPXI","https://ap.wps.com/l/cbCaill9SfNzWPXI","pdf",127570,"English","# Student Information\n## Parent/Guardian information\n## Relative Contact (if applicable)\n## Visa\n## Study history and Japanese proficiency\n## Pre-existing illness or condition\n## Minor pain or illness permission\n## Emergency hospital treatment\n## Foods and Dietary Needs\n## Other health information\n## Student Travel Details\n## How did you hear about our school?\n## Permission for Publicity Activities\n## Refund Policy","[{\"question\":\"What information is collected for the student and parents/guardians?\",\"answer\":\"The form collects the student’s family name, given name, kanji, birth date, gender, nationality, and optional fields such as religion and mother language. It also records parent/guardian name, relationship, address, and contact numbers (TEL/FAX, mobile) and e-mail.\"},{\"question\":\"What permissions are requested for health and emergencies?\",\"answer\":\"Parents/guardians grant permission for non-prescription medicines for minor pain or illness, and permission for the Course Director to sign necessary consent forms in case of emergency operation. The form also asks about pre-existing illnesses or conditions to help with preparation.\"},{\"question\":\"How is the refund handled when a course is cancelled?\",\"answer\":\"A full course fee is refunded if cancellation is made before the application deadline. After the deadline, a cancellation fee applies based on the cancellation date (ranging from 20% up to 100% from July 11 onward). Natural-disaster-related lesson cancellations are replaced with assignments and no refund is made for those lessons.\"}]","Summer Teen Program Application and Parent/Guardian Consent Form - Enrollment paperwork | PDF",1791176917]