Attach Photo

APPLICATION FOR ENROLLMENT
ANTICIPATED STARTING DATETHIS FORM MUST BE ACCOMPANIED BY:
1.
2.
3.
4.
5.
6.

One passport sized photograph
Report card of current and/or previous school year (or school Transcript)
Copy of Proof of residency for parent(s)/guardian(s) and student (e.g., resident card,passport, Jumin hyo/住民票)
Copy of current health insurance card
Document from physician stating that there are no major health problems prohibiting thechild from participating regularly in school (May be submitted before starting classes)
Sign and submit Parent/ Legal Guardian Agreement

PLEASE TYPE ALL SECTIONS
1. STUDENT INFORMATIONFirst Name

Nationality

Middle Name

Religion

Surname

AgeGender

Date of BirthM・ F(dd/mm/yy)

Languages spoken at home

Address

Telephone

EmailMobile

Explain transportation to and from school2. PARENT/GUARDIAN INFORMATION
Please provide the following information on the persons legally responsible for the applicant.
A. Relationship to child: Mother/Father/GuardianFirst Name

Middle Name

Occupation

SurnameNationality

Languages

Employer

Address

Home Telephone

EmailMobile

B. Relationship to child: Mother/Father/GuardianFirst Name

Middle Name

Occupation

SurnameNationality

Languages

Employer

Address

Home Telephone

EmailMobile

3. ADDITIONAL EMERGENCY CONTACT INFORMATION
Please name an adult other than parents or guardian to be contacted if parents are unreachable.
NameMobile

EmailRelationship

4. ACADEMIC INFORMATION
Please list ALL schools that your child has previously attended beginning with the most recent
school (include Kindergarten and Pre-school experiences).
Name of School

Country

Language ofInstruction

Type ofCurriculum

Year Attended(MM/YYYY)
tototototo

Grade Level(S)Please list any extracurricular activities in which your child has participated. If he/she has received any
award or special recognition, please mention it.

5. STUDENT MEDICAL INFORMATION
Normal Body TemperatureAllergies

Other medical conditions

Name of Clinic

Phone℃
Name of Family Physician

Please state any other information that you feel may be important for the school to know about yourchild.

Liberty International School

Parent/Guardian Agreement

STUDENT NAME
Last nameFirst name

1. I understand that the filling out of this application
does not guarantee acceptance into Liberty International
School and Liberty International School reserves the rightto accept or reject any student applying for admission.
2. I understand that upon acceptance of my child to
Liberty International School, I am responsible for the feesand tuition for the full year, unless noted differently inthe tuition contract I sign.
3. I understand that before the first day of attendance,
fees and tuition must be paid in full or an Installment
Payment Plan must be in effect.
4. REFUND – I understand that if the need arises towithdraw a student before the new school year begins, arefund of annual fees and tuition will be given. If a
student must be withdrawn during the school year but
before the second term begins, a refund of tuition for thesecond term will be given. In this case, the parent orguardian will need to notify the school in writing.
NOTE: In order to receive a refund, this notification must
be received before the first day of classes for thespecific term.
5. I understand that Liberty International School has theright to prohibit any student from participating in an
activity if that student's behavior negatively affects otherstudents or classroom functions. Furthermore, Iunderstand that the school may permanently disenroll astudent for behavior that violates or conflicts with themission and vision of the school. Furthermore, no refundof fees or tuition will be granted in this case.
6. I understand that Liberty International School has theright to assess the grade level and language level of each
student in attendance.

Middle name7.
I understand that photographs and videos of mychild(ren) may be taken to be used in various formats (e.g.,
printed or digital media). I hereby grant Liberty
International School permission to use, publish andreproduce for any legitimate purpose excerpts from printed
or digital content, such as may be retrieved from written
art works, essays, or school activities, etc. This media may
be used for professional development and educational
research. Identifiable information will not be displayed.
8.
I voluntarily relinquish any claim against Liberty
International School, its governing authorities,
administrators, teachers, and volunteers, in the case of any
accident my child(ren) may be involved in while at school,on any school outing or activity, and during transportationto and from school.
9.
If a parent or legal guardian cannot be contacted in
the event of an accident or injury to my child(ren), Iauthorize Liberty International School officials to takewhatever action they deem to be necessary in order toassure the best health care for my child(ren).
10. I understand that Liberty International School
provides children an equal opportunity for education.
Things such as, but not limited to, nationality, race, color,gender, or religion will not be a factor prohibiting
a student from attendance.
11. I understand that as a general rule, if I unenroll
my student from Liberty International School and then later
decide to return to the school, I will need to redo theapplication and pay the one-time fees again. In
such situations, I understand that a space for mystudent is not guaranteed upon returning. Exceptions
to this rule may be given at the discretion of theadministration.

Signatures
Parent 1/Legal Guardian

Date

Parent 2/Legal Guardian

Date

OFFICE USE ONLYYear

Enroll ID

Starting Date

BusAgreement

Textbook

Paid By

Office signRegistrar sign

Date

Date

ACCEPTANCE OF ENROLLMENT
The enrollment ofis accepted to commence classes on

SignedDateOperations Manager

Head of School

dd/mm/yy

SPECIAL CONDITION OF ENROLLMENT
This enrollment is accepted contingent on the following special conditions:

SignedDateOperations Manager

Head of School

dd/mm/yy