確認同意書
Consent Form
Please read [Admission・User Guide] before application surely.

Check Box

Please read all conformation items carefully and check the box.
①
②In order to calculate the correct fee for childcare, the Childcare Division will acquire
information from other City departments and share it with facilities as necessary.
In case the screening process take much time because of rush of application,
it will takes more than 30 days to send the result.

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Please visit and inspect preferred facilities with applying child.

③ Please check expenses other than childcare fees with the facility.

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If child has any allergy, illness and disabilities, please report to the facility in advance .
If it becomes evident after enrollment into childcare that the actual situation is different from

④ what was described in the application, the enrollment can be withdrawn without the right to file□a complaint.
If your situation changes after you have submitted an application, you must inform the⑤Childcare Division and carry out the procedure immediately.(e.g.: changes in family situation
because of marriage, divorce, moving or changes in reason for childcare because of□employment, illness)⑥ Please adjust the term and details of gradual entry with the facility admitted.
⑦⑧⑨The Childcare Division will inquire tax information of guardians and relatives from affiliatedorganization as determine the childcare fee.
You have to pay the childcare fee by the designated date without fail. If you don't pay, you will
receive a demand notice and it will be disadvantage for the application of siblings.
Please provide the documents needed to calculate the child care fee. If the Childcare Division
cannot check your tax information, the childcare fee will be the highest possible fee.

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If the child under 8 weeks old is admitted, enrollment will begins on the first day of the month,⑩ but the child can start using the facility after 8 weeks passed. Even in this case, the childcare□fee will be full amount. ※Please check the start date with the facility.
In case you would like to cancel the admission, you have to submit cancel form to the childcare⑪ division. If you would like to apply another facility from next month, you have to submit all□documents of application again.

⑫Valid period of application is within this year. If the child cannot be admitted within this year,
you have to apply again.

□<Those who apply for Transfer>⑬ After admission of transfer, you have to leave the original facility whatever. In case you decline□

the admission either.
<Those who apply to facility located outside Hirosaki City (Wide Area Application) >⑭ Please contact the municipality of preferred facility and check required documentation,□deadline and if it's possible to apply or not.
<Those who plan to move in Hirosaki City and apply to the facility located in Hirosaki City>
Only in case that you can submit the certification of address in Hirosaki as of 1st of applying⑮month.(Require either of copy of the lease agreement, construction contracts or certificate ofwill to live together)Without the certification of address, please apply from your municipality. In
case that you cannot verify the address in Hirosaki City as of 1st of applying month, yourapplication will be invalid. The admission will be revoked as well.

I agree with all items.
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