Kinmon Gakuen Fall 2026 - Spring 2027 Registration Form

Kinmon Gakuen Fall 2026- Spring 2027 Registration Form

Japanese Classes for Children Ages 5 to High School
Important: A separate registration form is required for each student.
If you are registering more than one child, please submit a separate form for each child. A $50 registration fee is required for each student. Tuition for siblings may be paid together on one form.

Please note: Class placement and levels may be adjusted depending on enrollment and student proficiency. Current planned class groupings are Beginning, Intermediate, and Advanced. If the minimum number of students is not met, a class may be canceled and a full refund will be issued.

Registration Fee: $50

Tuition: $500

Class Schedule: Every Saturday

Fall Semester: August 29 to December 12
Spring Semester: January 23 to May 15

Class Time: 9:00 AM – 12:00 PM
Class Level

Class placement and levels may be adjusted later depending on enrollment and student proficiency levels.
Preferred Class Level
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
2 digit month, 2 digit day, 4 digit yearDate
Age as of August 29, 2026
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Email
example@example.com
Alternate Contact Email 2, if needed
example@example.com
If you use a different email address for Google Classroom, please enter it here.Gmail is recommended.
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.
Student's Background
What is the primary language at home?

Other
Whose idea is it to attend a Japanese Language school?

Other
Is this his/her first time attending a Japanese language school?
If No, where has he/she attended before?
Comments and Expectation from guardians.
How many children from your household will attend Kinmon Gakuen?

Other
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.
Family Doctor
Doctor Name
Clinic
Family Doctor Phone Number
Is there anything else regarding your child's health that we should be aware of?
School Policies, 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 through cropping or editing when appropriate. Photos may also appear in printed materials such as newsletters or community publications, where images are typically smaller or lower resolution.
As a parent or guardian of this student, I hereby consent to the use of photographs and/or video taken during the school year for publicity, promotional, and educational purposes, including publications and posting through newspapers, the internet, social media, or other media sources. I do this with full knowledge and consent 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
2 digit month, 2 digit day, 4 digit yearDate
Signature
Payment

Important: A separate registration form is required for each student. If you are registering siblings, please submit one registration form for each child. Tuition for multiple children may be paid together on one form, but payment does not replace the required registration form for each student.
Registration Fee

A $50 registration fee is required for each student once per academic year.

Students who have already paid the registration fee for the Fall semester do not need to pay it again for the Spring semester.

Registration Fee: $50 per student

Tuition

First child: $500
Siblings (second child and onward): $480 each

A separate registration form is required for each student. Tuition for siblings may be paid together on one form.

Payment Notice

This form may be submitted without tuition payment. The registration fee is required at the time of registration.

If you prefer to pay tuition by credit card or check at the office, please contact us by email in advance.
Payment Option: Registration Fee is required at the time of registration. Tuition may also be paid later by credit card or check during office hours.

Payments

Kinmon Gakuen Registration Fee

$50.00

Kinmon Gakuen Fall 2026

August 29, 2026 to December 12, 2026

$500.00

Kinmon Gakuen Spring Semester 2027

January 23, 2027 to May 15, 2027

$500.00

Sibling: Fall Semester 2026

For the second and additional children. A separate registration form is required for each child.

$480.00

Sibling: Spring Semester 2027

For the second and additional children. A separate registration form is required for each child.

$480.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Kinmon Gakuen Fall 2026- Spring 2027 Registration Form

Class Level

Student Information

Parent(s)/Guardian(s) Information

Student's Background

Emergency Information

Health Information

School Policies, Waiver and Release of Liability

Photo Release Permission

How did you hear about this summer program?

Signature

Payment

Payments

Payment Methods