Application for Admission

Child’s Name: ___________________________________________________________________________
Family NameFirst Name
(Nick Name)_________________
M/F

Date of Birth: _________________________________ Age:___________ Preferred Starting Date: __________________
Month / Day / Year
Nationality: _________________________ Languages Spoken: _________________________________________________FirstSecond

Address in Japan: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Home Tel: _________________________________________ Mobile:__________________________________________________
E-mail: __________________________________________________________________________________________________________How did you hear about our school? (Please circle one)
① Internet ② Magazine ad () ③ Re-location company (④ Summerhill Staff ⑤ Friend ⑥ Other ())

Father’s Information
Farther’s Name: ______________________________________________________ Nationality: _________________________(English)(Kanji if available)

Languages Spoken: _________________________________________________________________________First

SecondEmployer: ______________________________________________ Title of Position: _________________________________
Work Tel: ______________________________________________ Mobile number: _________________________________
Business Address: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Mother’s Information
Mother’s Name: _______________________________________________________ Nationality: ________________________(English)(Kanji if available)

Languages Spoken: ____________________________________
First_____________________________________
SecondEmployer: ______________________________________________ Title of Position: ________________________________Work Tel: ______________________________________________ Mobile number: __________________________________
Business Address: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. What are the reasons for choosing our school?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What expectations do you have from our school?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Has your child previously attended any pre-school? Please provide the name of the school.
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Has your child received any developmental therapy or counseling? If so, please describe.
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Is your child toilet trained? Students from K3 to K5 are required to be toilet trained.
Yes / Not yet

6. Is there anything else we need to know about your child?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

We have read and understood the Summerhill International School Policies and have filled out theapplication fully and accurately. Once the application is submitted the invoice will be issued. Obligation
to pay the invoice will be effective once it has been issued.

______________________________________
Father’s Signature_______________________________________
Mother’s Signature___________________
Date--------------------------------------------------------------------------------------------------------------------------------Office Use:

Requested Days:

MondayTuesday

WednesdayThursdayFridayAvailable Days:

MondayTuesday

WednesdayThursdayFriday