Willowbrook International School Application Form 2024-2025“Planting the Seeds of Wisdom"
2-14-28 Motoazabu, Minato-ku, Tokyo, 106-0046 JAPAN Tel (03) 3449-9030 admissions@willowbrookschool.com
Thank you for your interest in our school. Applications can be sent via mail, email or dropped off in-person.
When do you wish your child to start?

Date of school visit
Month / Year

Month / Date

NameFirst

MiddlePreferred name for labels
Date of Birth
MonthLast

漢字氏名 Japanese, if available/// Date / Year

GenderNationality(ies)
Address in Japan(In Kanji, if available)

Parent/Guardian Information
Parent/Guardian 1

Parent/Guardian 2

Name
漢字 (Kanji, if available)
Relationship to Child
Nationality(ies)Language(s)Phone
E-mailEmployer
Position/Title
Business Address(Kanji, if available)

Business Phone
Check here to have the invoice sent directly to your employer
Sibling Information
Name

AgeSchool NameIn which program would you like your child to be enrolled? Please check the applicable days.
If you have a second choice, third choice, or more, please clarify.
For 2024-2025 school year (from August 2024 to June 2025)
Please Check Preferred DaysAge Group

ProgramHours

5 days -M/Tu/W/Th/F
3 days-M/W/F 2 days-Tu/Th

Birthdays to
Apply for2024-2025

8:15 -12:30

5 days3 days2 days8:15 -14:00

5 days3 days2 daysRegular8:15 -14:00

5 days3 days2 days

1st Sep 2021 31st Aug 2022

Dual Immersion

8:15 -14:00

5 days3 days2 days

1st Sep 2021 31st Aug 2022

3-4 years

Regular8:15 -14:00

5 days3 days2 days

1st Sep 2020 31st Aug 2021

3-5 years

Dual Immersion

8:15 -14:00

5 days

4-5 years

Regular8:15 -14:00

5 days

Optional Extension
Class (All Ages)

Regular

14:00 - 18:00(hourly basis)check here

15 months-2 years

Regular

2-3 years

1st Sep 2022 31st Aug 2023

1st Sep 2019 31st Aug 2021
3 days

1st Sep 2019 31st Aug 2020

If your child requires afterschool childcare upon enrollment, please

In order to best accommodate your child's needs, please complete the following questions as thoroughly as possible.
1. How did you find out about our school?
(If Willowbrook was recommended to you by somebody associated with the school, please ask that person tocontact us at the time of your application via email, phone or letter)

2. What are your reasons for choosing our school?

3a. What is the level of English proficiency of the parents/guardians?
(e.g., native or fluent in English, studied abroad, attended international school, etc.)

3b. What is the primary language your child speaks at home?

3c. What other languages are spoken at home?

4. Has your child previously attended a playgroup or another pre-school?
If so, please provide the name of school and address. (Please submit any progress reports)

5. What do you consider to be your child's strengths?

6. Does your child have any special dietary requirements, restrictions or health concerns?
(i.e., food allergies, religious reasons, etc.) Please indicate the seriousness of the allergy and whether
your child requires medical treatment for any exposure. Allergies are NOT a factor in admission decisions.

7. Is your child toilet trained?
Toilet training is required for 3-4 year olds and 4-5 year olds.
Yes/ Not yet

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

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

Medical Authorization and Other Authorization
I understand that the school will make every effort to reach the parents/guardians or designated emergency contact in the eventof an emergency. However, if the parents/guardians cannot be contacted, I authorize Willowbrook International School to takeany emergency measures necessary. I agree to be responsible for any expenses incurred in such an event.
(We will collect additional emergency contact information upon enrollment.)
My child has all the appropriate immunizations or will have, by the beginning of the school term and I will provide documentation
to the school upon enrollment.
If there are any concerns regarding the statements above, please contact the school.
Tuition Policy
1. Tuition fees will not be refunded under any circumstances.
No tuition refunds will be given due to the potential difficulty of enrolling another student to fill an open position once thesession has begun.
In case of a school closure for reasons beyond the school’s control, no tuition will be refunded. These reasons include but
are not limited to weather conditions and natural disasters, terrorist attacks, public transportation disruptions/strikes,
political/civil unrest, epidemics, pandemics, and any preventive and risk management measures taken for the safety of ourstudents and staff.
2. Tuition must be paid by the payment deadline of each term as stated below for the 2024-2025 school year.
Tuition may be paid in either one or two installments (Aug-Dec and Jan-Jun).
Due date
First Session (August - December, 2024)
middle of May, 2024
Second Session (January - June, 2025)
middle of November, 2024
3. A one-time non-refundable Registration Fee is payable upon the child's entrance to the school.
4. A one-time non-refundable Application Fee of 13,200 yen (tax inclusive) is payable upon application to the school.
5. Please have all payments made to the school's bank account. (Excludes optional extension class)
Attached Documents

Please check theappropriate box(es)Have you attached copies of your child's passport? (If available)
Have you attached a family photo?
Have you attached a recommendation letter? (Optional)
Have you attached any progress reports from the current or former school your child is attending/attended?
(If available)
Agreement(Advancing to the next step of the admissions process requires your agreement to the statements below)
I / We have or will arrange to transfer the application fee to the school account.
Please refer to Page 2 of the Financial Policy for account information.
I / We agree that any letters of recommendations to other schools is confidential and waive the right to readthe completed document.
I / We have read the Policy Booklet and agree with the school's policies stated therein.
I / We agree with Willowbrook’s philosophy including outdoor and park play as well as the extra risks
associated with these activities
I / We have read the Tuition Policy and agree to the requirements stated therein.
I / We do not belong to or have affiliation with any anti-social organizations.

Parent/Guardian 1 Signature:
Parent/Guardian 2 Signature:
Date:

Please check theappropriate box(es)