Welcome to the Kspace!
Please complete the fields in this form in full.
Add ticks in the dates that you would like your child to attend.
One form must be completed per child.
Once we receive your completed form an invoice will be prepared and sent to you.
Your booking is secure when our Admissions Team has approved your child's application and payment has been received.
We will contact you when we receive your details.
All fields with an asterisk(*) are mandatory. This is not an enquiry form, it is for booking only. 

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

General Information

1) Are you an enrolled Kspace member? * No   Yes
2) Has your child ever attended a Kspace Spring/Winter/Summer School? * No   Yes
a)If 'Yes' to the above, please give details of programme and the year
b)If you answered 'No' to the above, have you ever visited Kspace before? * No   Yes

Student's Information

Surname (family name) *
Forename (first name) *
Gender *
Date of birth (dd/mm/yyyy) *
Nationality (nationalities) *
1st Language *
Other Languages *
English Language Level* Complete Beginner   Beginner   Intermediate   Advanced / Fluent  
If your child has studied English before please tell us where/how:

Student's Medical 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
Has your child received all vaccinations recommended in Japan? Yes No
Does your child have any special diet? (Please list) No Yes
Does your child take any medications? (Please list) No Yes
Please provide the name, address and telephone number of your child's medical centre/doctor

 

"I give full permission for members of school staff to authorise medical treatment in an emergency for my child and also to administer minor first aid if needed. I also give express permission for members of school staff to assist my child with the use or administration of EpiPen if there is reasonable cause to suspect allergic reactions."

Signature (first/ middle/family name) *

 

Authorisation Area

1. Media & Communication Release

1. Media & Communication Release

I authorise Kspace to take and use any student works, photographs, video or sound recordings of my child and any other reproductions or adaptations of my child’s likeness, either in full or part, in conjunction with any wording or drawings. I understand this material may be used for advertising, promotion, media publicity, publication, display or internet usage of Kspace in whole or in part. I understand that I, or my child, do not have any interest in the copyright to the material nor shall we receive any payment.

 

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I Agree I Do Not Agree

2. Park and Off-Site Trip Consent

2. Park and Off-Site Trip Consent

I give full permission for my child to be taken off the Kspace premises for roof and park play in their school group, if weather permits.

 

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I Agree I Do Not Agree

3. Code of Conduct

3. Code of Conduct

I understand any failure by my child/children to follow the Code of Conduct may result in his/her/their participation at the School being terminated, without refund. Kspace reserves the right to withdraw any student at any time. I understand that student attendance is only granted following receipt of all fees.

 

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Signature (first/ middle/family name) *

4. Terms and Conditions

4. Terms and Conditions

 

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Signature (first/ middle/family name) *

Print Authorisations and Terms

Print Authorisations and Terms

 

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Parent/Guardian Contact Information
Address in Japan
Please list the name of the primary English speaker in 'Parent A', if you have an English speaker in your family.
Parent A's Name (first name/family name) *
Relationship to Student *
Nationality *
Parent B's Name (first name/family name)
Relationship to Student
Nationality
Address *
Address (continued)
Postcode *
Phone / Landline
Mobile *
Email Address *
Note: Please do not provide mobile phone provider email address

 

How did you hear about us?


Please add a tick mark ( ✔ ) in the boxes on the dates/courses/times that you would like your child to attend.

To give you an accurate invoice please complete fields for every date that you want to book.

Booking Dates

MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Mar 16
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 17
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 18
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 19
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 20
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 21
Regular Programme
9.00am to 2.00pm
After School
2.00pm to 3.00pm
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
 
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Mar 23
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 24
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 25
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 26
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 27
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 28
Regular Programme
9.00am to 2.00pm
After School
2.00pm to 3.00pm
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
 
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Mar 30
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Mar 31
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 01
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 02
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 03
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 04
Regular Programme
9.00am to 2.00pm
After School
2.00pm to 3.00pm
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
 
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Apr 06
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 07
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 08
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 09
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 10
Regular Programme
9.00am to 3.00pm
After School
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm
Apr 11
Regular Programme
9.00am to 2.00pm
After School
2.00pm to 3.00pm
3.00pm to 4.00pm
4.00pm to 5.00pm
Breakfast Club
7.30am to 8.00am
8.00am to 9.00am
Extension Hrs
5.00pm to 6.00pm
6.00pm to 7.00pm


Completing this field acts in place of your handwritten signature, in agreement with the authorisations above and for booking application at Kspace International School.

Date *:

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