Saturday Afternoon Program 2026 Application Form

Kinmon Gakuen Saturday Afternoon Program Application Form

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

Program Schedule

September Course
The September course will be held on four Saturdays:
September 5, 12, 19, and 26, 2026.
Classes will take place from 1:00 PM to 3:00 PM (2 hours per session).

October Course
The October course will be held on four Saturdays:
October 3, 10, 17, and 24, 2026.
(No class on October 31.)
Classes will take place from 1:00 PM to 3:00 PM (2 hours per session).

November Course
The November course will be held on three Saturdays:
November 7, 14, and 21, 2026.
(No class on November 28.)
Classes will take place from 1:00 PM to 3:00 PM (2 hours per session).

Course Selection

Rows	Please select
September Course $200
October Course $200
November Course $150

Course Selection

Rows	Please select
October Course $200
November Course $150

Course Selection

Rows Please select

November Course $150
Student Information

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

First NameLast Name
Japanese Name (If applicable)

First NameLast Name
Grade
Japanese Language School Last Attended
Gender
Date of Birth

MonthDayYear
Date
Age as of Sep 5th, 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 in order of whom to contact first
Emergency Information
※ Please provide an Emergency Contact who is NOT the same person as the applicant.
For safety reasons, the applicant and the emergency contact must be two different people.
If they are the same, we may not be able to reach anyone in an emergency.
Name: Emergency Contact

First NameLast Name
Relationship :Emergency Information
Phone Number :Emergency Information
Format: (000) 000-0000.
Health Information
Please let us know if this child has any allergies.
List medications if this child is currently taking
Additional health information (optional)
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/videotape taken during the course of the school year for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet, SNS or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
How did you learn about this program?
How did you learn about this program?
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.

Afternoon Class September

$200.00

Afternoon Class October

$200.00

Afternoon Class November

$150.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Kinmon Gakuen Saturday Afternoon Program Application Form

Student Information

Parent(s)/Guardian(s) Information

Emergency Information

Health Information

Waiver and Release of Liability

Photo Release Permission

How did you learn about this program?

Signature

Payment

Payment Methods