2104 Summer Camp Registration

セッション2,3は、定員に達した為申し込みを締め切りました。

尚セッション1は、引き続き受け付けています。

Session 2,3 is now full as of April 30th.
Session 1 is still open.

space

    *indicates required field
    日本語入力可能

    *Camper's Last Name

    *Camper's first Name

    日本語名（漢字）

    日本語名（ふりがな）

    *DOB（YYYY-MM-DD 生年月日）

    Age (on the first day of camp)

    Current Grade (as of today)

    *Boy/Girl?
    BoyGirl

    Does your child attend a Japanese environment school/Yochien?
    YesNo

    If yes, which one?

    How many years lived in Japan?（日本滞在年数）

    *Guardian #1 Name （保護者氏名）

    *Guardian #1 Phone Number

    *Guardian #1 Email Address

    *Guardian #1 Mailing Address

    Guardian #2 Name

    Guardian #2 Phone Number

    Guardian #2 Email Address

    How did you hear about this camp?

    If you heard from a friend, or saw an ad, please write WHO/WHERE

    *Sessions

    Allergies and any other health information (アレルギー)

    Payment
    Personal CheckCredit Card

    Consent Emergency Medical Authorization and Release

    *Please read carefully

    I give permission for my child to participate in the activities of the Japanese Summer Camp program. I understand that there may be a risk of injury to my child while participating in these activities. If I cannot be reached in the event of a medical emergency, I hereby give permission to O-en Network personnel to provide basic first aid treatment and to release personal and medical information about my child to first responders and medical staff and physicians rendering medical treatment. I give permission to the physicians selected by O-en Network personnel to render medical treatment, to hospitalize and/or to perform medical procedures that the physician deems to be medically necessary.

    I agree to waive all claims against O-en Network and its staff for injury, accident, illness or death occurring during or by reason of this event and emergency medical treatment.

    I have read and understand the above statement, agree to the terms of the Medical Emergency Authorization and Release and affirm that I am at least 18 years of age and the parent and/or legal guardian of the child participating in the Japanese Summer Camp 2014 program.
    I agree

    Initial

    The Use of Photo

    I allow O-en Network to use photographs taken during the camp. Photos will be used for O-en website as well as brochures for our future programs. Individual names will NOT be published.
    Yes, it is fine to use my child's photoNo, I do not want my child's photo to be used

    Initial

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