Summer Experience Application Form

Sorry, we have closed the online application for Summer Experience. Please contact the Summer Program Office for further inquiry.

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 summer@canacad.ac.jp to make alternative arrangements for enrolling and payment.

Student Information (参加者)

名​​
性​​
生年月日​​
性別​​
Students applying must be at least 4 years old by September 30, 2017. 
現在の学年​​​​​​​​
カネディアン・アカデミイの学生ですか​
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​​​​​​
Please check the weeks you wish your child to attend: ​​​​​​​​​​​​​​​
If you want to attend Extended Fun​​ please select the weeks​​​​​​​​​​
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

9:00-9:50​​​​​​​​​​​​
10:35 - 11:25​​​​​​​​​​​
1:15 - 2:05​​​​​​​​​​​​​​​
2:10 - 3:00​​​​​​​​​​​​​​

Summer Experience Week 2

Summer Experience Week 3

9:00-9:50​​​​​​​​
10:35 - 11:25​​​​​​​​​
1:15 - 2:05​​​​​​​​​​​​​​
2:10 - 3:00​​​​​​​​​​​

Summer Experience Week 4

9:00-9:50​​​​​​​​
10:35 - 11:25​​​​​​​​​​
1:15 - 2:05​​​​​​​​​​​​​​
2:10 - 3:00​​​​​​​​​​

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​​
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?​​
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​​​
あれば詳しくお書き下さい​​​​

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. 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.
本プログラムではお子様の経験をたくさんの写真やビデオにおさめます。毎年これらをパンフレットや学校のウェブサイトに使用することがあります。使用する際は保護者の皆様に了解を得ます。 

同意する​

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。 

同意する​
  • If your child is diagnosed with a communicable illness, you must inform the office.
    お子様が何らかの伝染病にかかった場合には速やかにお知らせ下さい。 
  • 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.
    下痢や嘔吐/吐き気においても、症状がなくなってから24時間経った後、登校できます。
  • 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.
    朝8:45以前と放課後の3時以降にはお子様達の安全を監視するスタッフがいません。朝は8:45以降に登校し、放課後は速やかに下校してください。
  • 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.
    入学に際し、試験や面接は行いません。したがって、入学時もしくはプログラムが始まった後に不適切な行動、行為があると判断された場合は、カネディアン・アカデミイはその生徒に対し、入学申し込み、もしくはプログラムの続行をお断りする権利を保持します。
  • 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 http://www.canacad.ac.jp/.
    自然災害や流行疾患等で休校になった際、返金は致しません。休校になる際は朝6時にウェブサイトでお知らせします。 <http://www.canacad.ac.jp/>  
  • 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.
    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。
同意する​
保護者の氏名​​​
日付​​​
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Payment

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