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Summer Experience 2021

Please note that before enrolment using this form is completed, payment must be made by credit card. If you do not have access to a credit card please email to make alternative arrangements for enrolling and payment.

Student Information (参加者)


Canadian Academy Students applicants or students admitted for the 2021-22 academic year must be at least 4 years old by September 30, 2021. Other students must be at least 5 years old by September 30, 2021.


Select the size your child will need this summer​​ この夏用のサイズをお選び下さい​​​​​​
Please check the appropriate box for your first choice. Please note that your first choice will NOT be granted if it already has a maximum number of students.

Summer Experience Week 1

10:35 - 11:25​​​​​​​​​​​​​
12:35 - 1:25​​​​​​​​​​​​​​​
1:30 - 2:20​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Summer Experience Week 2

10:35 - 11:25​​​​​​​​​​​​​​​
12:35 - 1:25​​​​​​​​​​​​​​​
1:30 - 2:20​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Summer Experience Week 3

10:35 - 11:25​​​​​​​​​​​​​​​​​
12:35 - 1:25​​​​​​​​​​​​​​​​
1:30 - 2:20​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Parent Information (保護者)

Parent's name

Health Information


Letter of Consent (同意書)

Photo and video permission: Throughout the program students and staff will be taking photographs and video of their learning and fun. Most of this will take place at school and some outside. We will be posting them on our website for parents and students to see, and possibly be used for brochures/flyers for the following year. Our conduct will of course adhere to the CA rules already in place regarding use of student photos, and normal safety precautions will be followed at all times.


Medical release: I hereby give permission for staff at Summer Program to treat my child for minor abrasions if necessary. In the event where emergency medical treatment is required and where the parents cannot be contacted or there is no time to contact parents prior to treatment, I authorize the school to seek emergency medical treatment for my child. I understand that I will be notified of any additional medical aid given.
私は Summer Program のスタッフが必要に応じて擦り傷等の簡単な手当をする事を認めます。また、カネディアン・アカデミイの指導のもとに行われる学校活動に際して緊急医療手当の必要が応じた場合、 医療機関において応急手当を受ける事に関して、同校のスタッフが私に代わり判断を下す事を承認します。 

  • If your child is diagnosed with a communicable illness, you must inform the office.
  • Canadian Academy has a ‘24 hour fever free’ policy. Students can return to school when they have been fever free without fever reducing medication for 24 hours.
    カネディアン・アカデミイでは '24 hour fever free' ポリシーがあります。解熱剤なしで24時間平熱が続けば登校できます。
  • Students can return to school when they have been free of the symptoms of diarrhea or nausea/vomiting for 24 hours.
  • Supervision in the morning and after school: Summer program hours are from 9:00 AM - 3:00 PM. Please do not send your child to school before 8:45. Please either pick up your child at or shortly after 3:00 PM or instruct him/her to return home soon after school finishes. We do NOT provide playground/gym supervision before 8:45 AM and after 3:00 PM.
  • Because there is no entrance exam or interview, Canadian Academy reserves the right to ask a student to leave, even after the start of summer school, if his or her behavior is repeatedly or extremely inappropriate.
  • Typhoon, earthquake, or other “acts of God”: No refund for any summer program related fees in the case of cancellation of the summer program and/or activities due to typhoon, earthquake, or other extreme events beyond the control of summer program staff. This includes cancellation of the summer program due to epidemic outbreaks or any other government mandated closures. In case of school closure, we will announce it on our school website by 7am.
  • Privacy Policy: Canadian Academy Summer Program only collects personal information necessary to administer the program. All information will be kept confidential under the Personal Information Protection Law, and will not be disclosed to any third parties or be used for purposes other than to administer the program.
    個人情報の保護について: お子様およびご家族に関する個人情報については、プログラム運営上必要な範囲においてご提出いただいています。これらの情報は、個人情報保護法のもと、適正に管理・使用し、同意を得ることなくプログラム運営以外の目的に利用することはありません。
  • For non-Canadian Academy students: Enrollment in CA Summer Program does not guarantee your child’s acceptance as a full time student at Canadian Academy.


You are about to be transferred to the payment page, where you will be asked to pay by credit card. Your total fee (¥) is calculated as:

Summer Experience for 1 week: ¥50,000

Summer Experience for 2 weeks: ¥95,000

Summer Experience for 3 weeks: ¥140,000

Extended Fun week 1: ¥10,000

Extended Fun week 2: ¥10,000

Extended Fun week 3: ¥10,000

Bento lunch week 1: ¥3000

Bento lunch week 2: ¥3000

Bento lunch week 3: ¥3000



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