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

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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

Student Applicant's Information
Surname (family name) *
Forename (first name) *
Other names/Nick names
Gender *	Date of birth (dd/M/yyyy) for example 25/Oct/2019*
Nationality (nationalities) *
Passport Number/Numbers*		We require a copy of passport(for overseas) or birth certificate(for Japanese national) upon acceptance
1^st Language *
2^nd Language *
Additional Languages
Start Date (dd/mm/yyyy) *
Name(s) of sibling(s) at Kspace *
Has any of the applicant's siblings attended Kspace in the past? *

School History	No	Yes (Please provide information)
Has your child been in childcare before?	No	Yes
Has your child been to school before? Please list the full name/type of school. School reports/notes may be required at a later date	No	Yes

School Continuity Please answer to the best of your ability. It's important that we try to assist you to plan ahead and to offer you recommendations about the best route for your child.
How long do your family* intend to be in Japan?
How many years* do you intend to stay enrolled at Kspace International School?
If you already know a primary/elementary school that you wish your child to enter in the future please kindly add comments (optional):

Applicant's Medical Information	No	Yes (Please provide information)
Eye Glasses *	No	Yes
Hearing Difficulty *	No	Yes
Any physical/cognitive/behavioural limitations or challenges? *	No	Yes
Drug Allergies *	No	Yes
Food Allergies *	No	Yes
Dietary Restrictions *	No	Yes
Environmental Allergies *	No	Yes
Other health concerns *	No	Yes
Vaccination Record*
- MR(Measles/Rubella) vaccination	No	Yes
- Mumps vaccination	No	Yes
- Rubella vaccination	No	Yes
- BCG.	No	Yes
- Chickenpox	No	Yes
- DPT-IPV(Diptheria Pertussis Tetanus & Inactivated Polio vaccine)	No	Yes
- Japanese Encephalitis	No	Yes
- Hepatitis B	No	Yes
- Hib(Haemophilus Influenzae Type b)	No	Yes
- Pnemococcus	No	Yes

Parent/Guardian Information	Mother	Father	Guardian
Surname (family name) *
Forename(s) (first/middle) *
Nationality (nationalities) *
1st Language *
2nd Language *
Additional Languages
Mobile Number *
Email Address * (Please do not provide mobile phone provider email address)
Occupation *
Employer * (when residing in Japan)
Employer's/company address * (in full with tel. no.)
Applicant lives with * (please tick as appropriate)	Both Parents Mother Father Others(please specify):

Contact Information (Address in Japan if possible)
Address *

Postcode *
Country *
Phone / landline
Mobile *

Invoice & Billing Information
I would like to be billed:*	Per Term Per Academic Year
Billed Parent or Company/Sponsor's Name:*

About your child

Describe your child’s strengths:*

Describe any areas of challenge or where your child needs support (practical, academic or social e.g. toilet training.)*

Please list your child’s interests, hobbies and any activities they enjoy e.g. favourite books/music, games etc.*

DATA PROTECTION STATEMENT

The information you provide on this form is required by Kspace International School as part of the admissions process. The data is stored and processed in-house, and not shared with any other parties or organisations.

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Parent/Guardian Online Signature

Signature *:

Date *: