Saturday School Application Form - Kspace International Preschool & Kindergarten Shirokanedai, Tokyo

Welcome to the Kspace Saturday Online Tour Request & 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

Please enter the code given

General Information
1) Are you an enrolled Kspace member? *	No Yes , If 'Yes' please go to question 3
2) Have you ever visited Kspace before? *	No Yes
3) Has your child ever had a trial? *	No Yes , If 'Yes' to the above, please give details of programme and the year

Student's Information
Surname (family name) *
Forename (first name) *
Gender *
Date of birth (dd/M/yyyy) for example 25/Oct/2019 *
Nationality/Nationalities (on passport) *
1^st Language *
English Language Level*	Complete Beginner Beginner Intermediate Advanced / Fluent
If your child has studied English before please tell us where/how:
Does your child have any English language support at home? *	No Yes
Expected Start Date (dd/mm/yyyy) *
My child will usually attend *:
Do you think your child will usually attend *:
Name(s) of sibling(s) at Kspace *

School History
Does your child go to school/daycare? *	No Yes, If 'Yes' please write 'Japanese' or 'International'

Student's Medical Information	No	Yes (Please provide information)
Does your child have any physical challenges or limitations at all? *	No	Yes
Does your child have any cognitive, behavioural or social challenges or limitations at all? *	No	Yes
Does your child have any allergies at all? *	No	Yes

Parent/Guardian Information	Mother	Father	Guardian
Surname (family name) *
Forename (first name) *
Nationality/Nationalities (on passport) *
1st Language *
2nd Language *
Mobile Number *
Email Address * (Please do not add a phone provider email address - we prefer Yahoo, Gmail, Hotmail etc. please)

Contact Information	Address in Japan
Address *

Postcode *
Phone / landline
Mobile *
Optional Additional Info.
Please help us to get to know your child. Do they have any special interests, likes/dislikes, music ability, talent, favourite sports etc?

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 understand that there may be times when my child is taken outdoors, on the school rooftop or on scheduled field trips. I give my permission for this.

I authorise Kspace to act appropriately in a medical or natural emergency, including taking my child to hospital or seeking further medical aid if necessary.

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

Type Name in full (first/ middle/family name) *:
Date *:
Sign *: