5-13-39 Shirokanedai, Minato Ku, Tokyo 108-0071

〒108-0071 東京都港区白金台5-13-39

JP MAP/地図

03-5421-4186 / 03-3446-3478 enquiries@kspacetokyo.org

1-to-1 Music Lessons Birthday PartiesWinter School 2017

Kspace Parent & Child Programme Application Form

Welcome to the Kspace Online Application Process! Please complete this form. One form must be completed per child.
All fields with an asterisk(*) are mandatory.

Kspace International School, 5-13-39 Shirokanedai, Minato Ku, Tokyo 108-0071, Japan
kspace@kspacetokyo.org     enquiries@kspacetokyo.org

Membership Information

1) Have you ever visited Kspace before? * No   Yes
2) Has your child ever had a trial? * No   Yes , If 'Yes' to the above, please give details of programme and the year
3) Which membership are you applying for? * Main Kspace Membership
Saturday Membership (only needed for child-only Saturday School)
4) How many tickets would you like us to add to your first invoice? (Blocks last one calendar month): * One single
Block of 4
Block of 6
Block of 8
Block of 12

Programme Information

The name of the Parent & Child class/classes you are initially enrolling for (your Membership will cover all age groups): * Kspace Baby (Ages 3 to 14 months, not walking)
Kspace Toddler (Ages 12 to 26 months)
Kspace Junior (Ages 1.5 years to 4 years)
Saturday Family Circle Time (Ages 6 months to 2.5 years, mixed age group)

Family Information

Mother's Name (first/family): *
Father’s Name (first/family): *
Child’s Name (first/family): *
Child’s Nationality: *
Child’s Gender *
Child’s Date of birth (dd/mm/yyyy)*
Primary Parent’s Phone no: *
Email Address * (Please provide an email address that we can send attachments/information to e.g. Gmail, Hotmail etc., not a phone provider)
Home Address *
Child's English level *
Native   Fluent   Conversational   Beginner   None
Do you have an English speaker in the home? *
Yes   No
Authorisation Area

This is an online form and parents might be asked to read general school policies and sign them separately.

Submission of this form means that you agree to school policies and all points below.
The data that you submit online will be treated and stored with absolute respect and confidentiality. In the case that an application is not approved, all data will be removed within 24 hrs.
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Parent/Guardian Online Signature

I understand that children enrolled in Kspace programmes are featured in community newsletters, video recordings, and occasionally media is also used in marketing material. I give my permission for this.

I am the parent/guardian and all information above is correct.

Type Name in full (first/ middle/family name) *: *
Date *:
Kspace International School, 5-13-39 Shirokanedai,
Minato Ku, Tokyo 108-0071, Japan
kspace@kspacetokyo.org     enquiries@kspacetokyo.org
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