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Application for Approval of Education and Childcare Benefits and Application for Admission (Transfer) to a Childcare Facility【 Licensed childcare centers, centers for early childhood education and care, other licensed childcare facilities, etc. 】* We do not accept applications by fax or email.

Dear Mayor of Edogawa Ward, I hereby submit the following application.
Application date

DD/

MM/

*If submitted by mail or to a childcare facility,YYYY
chomeAddress Edogawa-ku①Name of parent/guardian*Notices and other documents will be addressed to Parent 1.

RelationshipgobanDate of BirthAge Occupation*Fill in only if different from the address above.
Place of residence on January 1st, 2023

Furigana

1・Individual
NumberFurigana（2・IndividualNumberChome）

Cell phone

Ban（Chome）

Go

Ban

City/Town/Village

Prefecture

Chome

City/Town/Village

Prefecture・Place of residence on January 1st, 2024

City/Town/Village

Prefecture・

Cell phone

Please submit the form without your Individual Number.

Ban

City/Town/Village

Prefecture

GoGo

ChomeBanGo◎I accept the contents of the admission guidelines and apply for certification for education and daycare benefits for children and admission (transfer) to a daycare facility as follows, along with the required documents.

② Name of child applying for certification andRelationshipfamily members living with the child*Fill in siblings, grandparents living together, etc.

Date of BirthOccupation /Name
Age of facility where you Category of application for certification Name of first choice facility
are enrolled*Only check for the child applying

Furigana

3Child・・

Individual
NumberFurigana□ Group 3 (under 3 years old)4・□ Group 3 (under 3 years old)・□ Group 3 (under 3 years old)・・・・and Care/Kindergarten*For children applying for certification for the
first group, enter the unofficial nursery school
Nursery school/Centers for
Early Childhood Education
and Care/Kindergarten*For children applying for certification for the
first group, enter the unofficial nursery school□ Group 1 (kindergarten, etc. only)□ Group 2 (over 3 years old)・Individual
NumberFurigana

6

Nursery school/Centers for
Early Childhood Education□ Group 1 (kindergarten, etc. only)□ Group 2 (over 3 years old)・Individual
NumberFurigana

5*Only write in for the child applying□ Group 1(kindergarten, etc. only)□ Group 2 (over 3 years old)

Nursery school/Centers for
Early Childhood Education
and Care/Kindergarten*For children applying for certification for the
first group, enter the unofficial nursery school

Individual
NumberFurigana

7
Individual
Number

③ Necessity ofchildcare*Check one of thefollowing④ Preferredhours*Check one of thefollowing boxes

I request to use childcare services at a childcare center, etc. due to*"Nursery school, etc." means licensed daycare centers (ward and private), certified childcare centers (nursery school

childcare services at the same time as a kindergarten, etc.)

centers.
*The term "kindergarten, etc." refers to some private kindergartens and centers for early childhood education and care(kindergarten portion).
*If "No" is selected, the following items (4), (5) and the reverse side do not need to be filled in.

□ Yes parental employment, illness, etc. (including cases where the child is applying for portion), small-scale childcare centers, family-style childcare centers, on-site childcare centers, and in-home daycare
I request to use a kindergarten, etc. (except in the case of joint□ No application with a childcare center, etc.)□□

Standard Childcare Hours (Within the opening hours of each *The hours listed on the left are the maximum hours that each facility can accommodate. These hours are not the sameas the hours your child is taken care of (childcare hours). The hours of operation vary from facility to facility, and any
facility, up to 11 hours )time outside of those hours will be treated as extended care.
Reduced Childcare Hours (Within the opening hours of each *If you wish to apply for shorter hours, even if your application can be certified for standard hours, it will befor shorter hours.
facility, up to 8 hours )⑤ Reasons for

Status of the father

requiringchildcare□ Working□ Disability*Check one of thefollowingNon□ existent

Care and□ nursing

Disease/Status of the motherJob search-□ related

Disease/Job search-pregnancy□ Disaster recovery □ Working□ Disability□ related□ /childbirthNon□ existent

Care and□ nursing□ Schooling□ Other(□ Schooling □ Other()□ Disaster recovery)⑥ Notes on the provision of tax information, etc., the levy and collection of childcare fees, and the approval of education and childcare benefits, utilization adjustment, etc
I agree to thefollowing terms
and conditions.

DD/MM/

Please sign it yourself.

YYYY Name of parent/guardian (signature)（1） I agree to the following from the application date until the end of the validity period of the certification of provision (in the case of a child who has entered kindergarten and graduated from kindergarten)（ⅰ）To confirm whether or not Edogawa Ward has information based on the Basic Resident Ledger, information on the levy of resident tax, information on foreign residents, whether or not theyreceive child support allowance, whether or not they receive public assistance, information on disabled persons, etc., of the guardians (including those from the same household) necessary forthe authorization and utilization adjustment of education and daycare benefits for children (hereinafter referred to as "certification"), and other information such as the employment status of
the guardians, and to investigate and obtain information necessary to confirm the necessity of childcare (including ex officio confirmation of one's own number and information linkage among
local governments using one's Individual Number). In addition, such information shall be shared among related organizations (including specified education and childcare facilities, etc.) andthe user-paid amount (childcare fee) determined based on such information shall be presented to the specified education and childcare facilities, etc.
（ⅱ）Submit by the due date the various required documents requested by Edogawa Ward for certification, utilization adjustment, continuation of enrollment, status confirmation, and determinationof user-paid amount (childcare fee). You may be asked to submit documents that can be omitted because they are subject to information linkage. In addition, other documents may be requested
separately as necessary.
（ⅲ）Continued compliance with certification and attendance requirements.

(2) If (ii) or (iii) of (1) is not fulfilled, I agree for my child to be immediately withdrawn from nursery school or to have his/her education and childcare benefit certification revoked.
(3) If the criteria for certification and childcare services are not met, the preferred certification may not be attained.
(4) Due to the number of applications, it will take at least 30 days from the closing date of the application period to send the certification of provision and the notice of utilization adjustment
result (approval or disapproval) for April applications.
(5) Even if you are certified, if there are too many applicants for admission, your child may not be admitted to the facility of your choice, due to admission-related decisions. Even if your childis approved for admission, your approval may be cancelled if the child does not undergo an interview and medical examination, or if the results of the interview and medical examination
indicate that group childcare is not feasible.
(6) All required documents for certification must be submitted by the deadline. If the documents are not submitted, the application for certification may be rejected.
(7) If you no longer require the facility's services after getting certified, or if there is a change in the certification details (family or work situation, etc.), you must notify the ward.
(8) If the application content is not true, the certification may be revoked. In addition, if you move out of Edogawa Ward, or the certification's period of validity has expired, it will be regarded
as being cancelled

主管課記入欄
受付

収受番号

登録

書類請求 入園申込

認定

指数

入力

認定確認 指数確認 入力確認

1

2

3

父 就・疾・介・災・求・育・学・他

受付園・受付者

母 ・ 父 ・ 他

認 ①
定
区分 ②

1
1

記入しないでください2
2□本人確認済3
3

標 短標 短認
定期間□ﾏｲﾅﾝﾊﾞｰ確認済

．
．

． 1
． 1～～

母 就・疾・介・災・求・育・学・妊・他
就学前まで/満3歳未満まで/3カ月間
・・就学前まで/満3歳未満まで/3カ月間□ﾏｲﾅﾝﾊﾞｰ職権説明済

・・□民営化

宛
名番号

□その他

2024

（ Reverse side ）From 01/

Term of use

YYYY

MM/

*Application is required for each fiscal year.

□ Until entering elementary school
MM/□ Until the last day of

Reasons why childcare
cannot be provided at
home/reason fortransferring to anotherfacility

Name of the child
who is applying ①
Name of preferredfacility□ I request licensed nursery schools only
Furigana

Name of the child
who is applying ②

Visited on
DD

Visited on

Second choice

MM/
MM/
MM/

MM/
DD
⇒Please prepare and attach a separate sheet of□ paper for your 6th choice and subsequent choices□

Visited on

Third choice

Visited on

Fourth choice

Visited on

Fifth choice

Visited on□ Accompanying

Sixth choice
and onwards□

The child is placed in a licensed childcare facility, certified childcare
facility, company-led childcare facility, kindergarten, or other facility

Currentchildcaresituation)□[Nursery schools,kindergartens, etc.]

days perweek/Hours

Yes/No )I leave my child with a childcare provider(Name of childcare provider:MM：～：)□ None or Only facilities currently attended
MM

YYYY -MM[Nursery schools,kindergartens, etc.]

YYYY)

YYYY-(Past attendancehistory□ Yes ⇒Facility name(to the workplace⇒ Childcare center available()⇒Facility nameYYYY-(Past attendance
history

am/is taking care of my child at home.

child is placed in a licensed childcare facility, certified childcare□ Thefacility, company-led childcare facility, kindergarten, or other facility⇒Facility name
MMDD

MM/DD
⇒Please prepare and attach a separate sheet of□ paper for your 6th choice and subsequent choices□ Accompanying

Yes/No )□DDMM/□

I leave my child with a childcare provider(Name of childcare provider:

DDMM/

am/is taking care of my child at home.
to the workplace⇒ Childcare center available(DDMM/DD

Visited on

Fifth choice

Second choiceDD

Visited on

Fourth choice

MM/DD

Visited on

Third choice

Visited on

First choice

MM/

Current
childcaresituation

Furigana*Please do not abbreviate the name of the facility you wish to use or the circumstances of childcare services; make sure to write down the full name ofthe facility. If incorrect information is listed for the facility, it may be deemed invalid.
*If you have already visited with your child, please indicate the date of the visit.

First choice

Sixth choiceand onwards*Please check one of the following boxes

YYYY

days perweek/Hours：～：)□None or Only facilities currently attended□ Yes ⇒Facility name(MMYYYY -MMYYYY)

If simultaneously applying for two or more children (siblings) *Please check one of the following, out of boxes (1) to (3).

□ ① I wish to enroll my children only if I can enroll them during the same period and at the same childcare facility.
*Please note that if all siblings are unable to enter the same childcare facility at the same time, it will result in a rejection for all siblings .

□ ②If they can be admitted at the same time , I wish to enroll them, even if they are placed at different childcare facilities.
can be placed in separate childcare facilities, and for each one, I would like for the most highly-preferred childcare facility
Please select one of the items on the right…
□ Theyto be given priority□ I prioritize having my children placed at the same childcare facility, even if the facility ranks lower on the list of preferences.
*Please note that if all siblings are unable to enter the same childcare facility at the same time, it will result in a rejection for all siblings .

□ ③ Even if only one child can be admitted, I wish for the child to be enrolled.
Please check or write in who will take care of the child(ren) who is/are not admitted.
〔□ Childcare provider □ Certified childcare centers□ Company-led childcare facilities □ Child(ren) will come with me to work □ Grandparents □ Other()〕*If even one child is admitted to the nursery school, he or she will be withdrawn from the preschool if the requirements for employment and other items are not met.
Please consider who will take care of the child(ren) who is/are unable to attend nursery school.

◆ If you are applying for a private facility (first-time) in April, including siblings in the 0-year-old class, and you chose (1) or (2) above
The admission-related decisions for the enrollment into the 0-year-old class for April will be made from the second-time private school. For this reason, during the screening for the first-time private school, wewill make selections for children for the 1-year-old class and above without taking into consideration preferences listed in (1) and (2) above.
From the second-time private school onwards, we will adjust the use of the service, taking into consideration the preferences listed in (1) and (2) above.

History of withdrawing from school due tochildcare leave

Name of licensed
childcare facility()

Commutingperiod (MMYYYY-Withdrawn from nursery school

YYYY)

MM

主管課記入欄該当者 認申

申込書

家状

児状

父
母
祖父

/

祖母子

提出期限///

就証

シフト

自営診断書

/////////////////

親手//

障害

介・看在学///

生保

在留

保育

引越

記入しないでください//////////////

ひとり/

その他
/////////

備考