Kinmon Gakuen Summer Session (May–June 2026) Application Form

Kinmon Gakuen Summer Session (May–June 2026) Application Form

Japanese Classes for Children Ages 5 to High School
Note: If the minimum number of students is not met, the class may be canceled and a full refund will be issued. Registration will close once capacity is reached.

Japanese Language Classes for Ages 5 to 18

Class Schedule: 5 Saturdays, from May 30 to June 27

Time: 10AM - 12PM

Tuition: $300 (all inclusive)

Schedule
- May 30
- June 6
- June 13
- June 20
- June 27
Beginning Hiragana Class — For beginners / no Japanese experience needed
Beginning Kanji Class — Some Hiragana & Katakana knowledge recommended

Entering Japanese Language Classes for Age 5 to 18

Rows	Every Saturday May 30 to June 27 10AM - 12PM
Basic Hiragana Class (Beginner Level) ($300)
Introductory Kanji Class ($300)

Please select one class.
Student Information

We kindly ask that siblings also fill out separate registration forms.
Student Name

First NameLast Name
Japanese Name (If applicable)

First NameLast Name
Current Grade (in regular school)
Japanese Language School Last Attended
Gender
Date of Birth

MonthDayYear
Date
Age as of May 30th, 2026
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Alternate Contact Email 2, if needed
example@example.com
Parent(s)/Guardian(s) Information
Please list the parent(s) or guardian(s) in the order we should contact them. Click the + button to add another contact.
Emergency Information

In case we are unable to reach the registered parent/guardian, please provide an alternate emergency contact.
Emergency Contact Name

First NameLast Name
Relationship to Student
Emergency Contact Phone Number
Format: (000) 000-0000.
Health Information
Does this child have any allergies? If yes, please specify.
Is this child currently taking any medications that staff should be aware of during the program? If yes, please list below.
Is there anything else regarding your child's health that we should be aware of?
Waiver and Release of Liability
Photo Release Permission

We respect students’ privacy. When sharing photos on our website or social media, we make reasonable efforts to avoid clearly identifying individual students, including by cropping or editing images when appropriate. Photos may also appear in printed materials such as newsletters or community publications.
As a parent or guardian of this student, I hereby consent to the use of photographs and/or video taken during the course of the school year for publicity, promotional, and educational purposes, including publications, presentations, newspapers, the internet, social media, and other media sources. I give this consent with full knowledge and waive all claims for compensation or damages related to such use.
How did you hear about this summer program?
Please tell us the medium that led you to apply
If "Other", please specify where
Signature
Date of Registration

MonthDayYear
Date
Signature
Payment

Please make payments separately for each student. We kindly ask that siblings also fill out separate registration forms.