Summer Experience Application Form

Student Information (参加者)

名​
性​
生年月日​
性別​
Students applying must be at least 4 years old by Sept. 30, 2016. Enrolments for PreK and KA are now closed.
学年​​​
学校​
Select the size your child will need this summer​​ この夏用のサイズをお選び下さい​​​
Fees for Secondary Courses:
  • CPR/First Aid Certification: ¥15,500 (late fee ¥17,500)
  • Art Inspired Writing: ¥33,500 (late fee ¥36,000)
  • Other courses: ¥30,000 (late fee ¥32,500)
Please check the weeks you wish your child to attend: ​​​​
Please check the weeks you wish your child to attend. If your child takes CPR in the Secondary program then they can choose to take it either in week 1 or week 2 (check ONE of the top 2 boxes). Any other Secondary program course, they must choose week 1 AND week 2​ (check both of the top 2 boxes)​​
If you want to attend Extended Fun​​ please select the weeks​​​

KB & Grade 1 Elementary Summer Experience

Grade 2 & 3 Elementary Summer Experience

Grade 4 & 5 Elementary Summer Experience

Secondary Summer Experience 2016

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.
TUITION: (late fee after May 23)
  • CPR/First Aid Certification: ¥15,500 (¥17,500)
  • Art Inspired Writing: ¥33,500 (¥36,000)
  • Other courses: ¥30,000 (¥32,500)
  • Minimum of 4 students are required to begin the class
Please check the appropriate box(es) for the class(es) you’d like to attend:
9:20 - 10:10​​​
10:50 - 11:40​
1:15 - 2:05​​​​
2:10 - 3:00​​
9:20 - 10:10​​​
10:50 - 11:40​
1:15 - 2:05​
2:10 - 3:00​​​​​
9:20 - 10:10​
10:50 - 11:40​​​​​​
1:15 - 2:05​
2:10 - 3:00​

Secondary Summer Experience 2016

Parent Information (保護者)

保護者の氏名​​​
住所​​​
自宅電話番号​
携帯電話番号​
PCメールアドレス​
携帯メールアドレス​
緊急連絡先​(氏名)​
緊急連絡先(電話番号)​​

Health Information

アレルギーはありますか?​
あれば詳しくお書き下さい​
お子様について知っておいてほしい事があればお書き下さい​

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. If you do not wish to grant us permission to photograph or use your child’s photograph for possible brochure/flyer, please check the box below. 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 CA Summer School 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.
  • 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.
  • 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-school-related fees in the case of cancellation of school and/or activities due to typhoon, earthquake, or other extreme events beyond the control of summer program staff. This includes cancellation of school due to epidemic outbreaks or any other government mandated closures. In case of school closure, we will announce it on our school website http://www.canacad.ac.jp/.
  • Privacy Policy – 個人情報 – 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.
  • For non-Canadian Academy students: Enrollment in CA Summer School does not guarantee your child’s acceptance as a full time student at Canadian Academy.
  • 本プログラムの参加はカネディアン・アカデミイの入学を保証するものではありません。
保護者の氏名​​
日付​​

powered by finalsite