KSPACE WINTER SCHOOL 2024

BOOKING FORM FOR RESIDENTS IN JAPAN

General Information
1) Are you an enrolled Kspace member?	No   Yes (If you are a member, move to question 3. If you are not, answer question 2)
2) Please choose your preferred membership option: *Guest Visitor Only Membs covers this winter school only and cannot be deducted from any other type of membership in the future.	Guest Visitor Only (*¥10,000 per child) Kspace Midweek Memb (¥20,000 per child) Saturday Memb (¥40,000 per child & ¥10,000 annual fee)
3) Has your child ever attended a Kspace Spring/Winter/Summer School?	No   Yes
a)If 'Yes' to the above, please give details of programme
b)If you answered 'No' to the above, have you ever visited Kspace before?	No   Yes

Student's Information
Surname (family name) *
Forename (first name) *
Gender	Girl Boy
Date of birth (DD/MM/YY) for example born 25/Oct/2019 *	dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 M Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Please select date of birth
Nationality/Nationalities (on passport)
1st Language
Other Languages
English Language Level	Complete Beginner   Beginner   Intermediate   Advanced / Fluent
If your child has studied English before please tell us where/how:

Student's Medical Information	No	Yes (Please provide information)
Does your child have any physical challenges or limitations at all?	No	Yes
Does your child have any cognitive, behavioural or social challenges or limitations at all?	No	Yes
Does your child suffer from hayfever and do they ever take drugs for hayfever?	No	Yes
Does your child have asthma, and if so do they need an inhaler?	No	Yes
Does your child have any allergies at all? (state the allergy, its intensity and if they also require an Epi-Pen)	No	Yes
Has your child received all vaccinations recommended in Japan?	No	Yes
Does your child have any special diet (please list)?	No	Yes

Parent/Guardian Contact Information	Address in Japan
Please list the name of the primary English speaker in 'Parent A', if you have an English speaker in your family.
Parent A's Name (first name/family name) *
Relationship to Student
Nationality
Parent B's Name (first name/family name)
Relationship to Student
Nationality
Address
Postcode
Phone / landline
Mobile *
Email Address * Note: Please do not provide mobile phone provider email address

Winter School Uniform
T-shirt (number of items)	0   1   2   3   4   5
Long Sleeved Shirt (number of items)	0   1   2   3   4   5
Sweatshirt (number of items)	0   1   2   3   4   5
Sweatpant (number of items)	0   1   2   3   4   5

 

Please add a tick mark ( ✔ ) in the boxes on the dates/courses/times that you would like your child to attend.

To give you an accurate invoice please complete fields for every date that you want to book.

Booking Dates (Winter School - December 16th to 21st, 2024 & January 4th, 2025)
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
December 16 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	December 17 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	December 18 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	December 19 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	December 20 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	December 21 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
					SATURDAY
					January 4 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm

 

IMPORTANT NOTES & AUTHORISATIONS

New students may be asked to take a paid trial before winter school.

Acceptance of and adherence to policies will be required.

Guidelines and an orientation/starter pack will be sent to you when your booking is complete.

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Parent/Guardian Online Signature

I am the parent/guardian and the information I have provided is correct.

I have read, understood and agree to all policies on the link above.

Type Name in full (first/ middle/family name) : 
Completing this field acts in place of your handwritten signature, in agreement with the authorisations above and for booking application at Kspace International School.

The data that you submit online will be treated and stored with absolute respect and confidentiality.

Date :

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